In the world of health reform, the word “upstream” means investing in early intervention and treating small problems in the clinic before they become large enough to require hospitalization.
The Family Health Center of San Diego, the region’s largest network of community clinics, is doing so well in this regard when it comes to mental health care that top U.S. public health officials were invited to tour the site on Tuesday. I stopped by.
Dr. Mandy Cohen, director of the U.S. Centers for Disease Control and Prevention, tours City Heights Family Health Center on El Cajon Boulevard and highlights the facility’s resources, from family medicine and prenatal care to physical therapy and chiropractic. We observed how the ingredients were carefully blended.
Dr. Christopher Gordon, president of the Family Health Center, explained that mental health care is integrated into the daily care process at the organization’s more than 90 facilities.
During their visit, regardless of the reason for their visit, each patient answers two simple questions: whether they have ever had a problem with little interest or enjoyment in things, and whether they are depressed or depressed. Those who answer in the affirmative will be asked to answer nine additional questions, and depending on the results, they may receive immediate mental health care without leaving the building.
“It’s all integrated, so you can call a therapist and say, ‘Hey, this person’s score might need a little attention,’ and we can immediately have a warm handoff,” Gordon says. says Mr.
The Family Health Center’s approach to providing comprehensive services to patients was one reason the visit was included in the CDC director’s national tour promoting mental health services and suicide prevention. Another attraction is the eight-story building just east of the clinic, she added. This mixed-use, mid-rise structure will house a 20,000 square foot mental health clinic, the upper floors will be constructed from repurposed steel shipping containers, and will include 41 new housing units, including 18 is reserved for unhoused San Diegans.
“What’s really remarkable about that new building is that it includes housing,” Cohen said. “It’s hard to get sick if you don’t have stable housing or food security. So I really liked that they included housing as part of the new building.”
The idea of integrating mental health care into primary health care was first developed by University of Washington psychiatrist Jürgen Unitzer, who created a “collaborative care” model that calls for integrating mental health care into front-line primary care practices. It’s an idea that has grown over the decades since.
Most recently, Rady Children’s Hospital began using such a model in some of its primary care clinics with notable positive results. Researchers found that having frontline physicians screen young patients for signs of depression was associated with a 44 percent reduction in anxiety symptoms and a 66 percent reduction in depression symptoms. I discovered that. An internal analysis of patient referral patterns also found that patients tested in the clinic were less likely to visit San Diego Children’s Hospital’s psychiatric emergency department.
Domonique Hensler, Rady’s senior director of system-wide care, said in an early April interview that continuing challenges with expanding integrative psychiatric care in pediatric clinics are encouraging family physicians to screen for signs of depression. They said they were not trained to carry out this procedure, and that social workers were not trained to screen for signs of depression. Instead of seeking help right away, ask your health insurance company to reimburse you for the work.
“Some companies are starting to remove, or have already removed, previous licensing requirements, which is a game-changer, but others are still getting a foot in both worlds,” Hensler said. Ta. “We outsource some of our health care plans to third-party vendors and have mental health care carve-outs with other agencies.”
Medi-Cal, the health insurance of last resort for California’s neediest residents, also has several programs in place that can support the integration of mental health care within clinics, but existing The program does not fully fit into the system created by the company’s pediatric clinic. analysts said.
Luke Bergman, director of behavioral health for San Diego County, said in a recent interview that federally qualified health centers, such as Family Health Centers, have increased ability to receive these services covered by Medi-Cal. Mr. Gordon also acknowledged that fact.
What will it take to fully entrench this treatment across American healthcare?
Part of the process is also talking to experts from around the country, she said. Cohen said understanding how health care providers better incorporate mental health into routine visits could help change the system.
“Then you can go to your Medi-Cal or Medicare partners and say, ‘Look, this is the best evidence,'” Cohen said.
