An elderly man with hypertension waits at a medical center for a blood pressure check; the nurse is unaware her patient is depressed and suicidal. A pregnant teenager also sits in the waiting room. Anxious over her baby’s future, she suffers from insomnia and drinks alcohol nightly to sleep. Another patient, a middle-aged woman, has an appointment for a prescription refill; the doctor doesn’t know his patient is also taking her husband’s pain pills.
Unfortunately, this scenario is not unusual. Behavioral health, “a state of mental/emotional being and/or choices and actions that affect wellness,” is not always assessed and treated along with medical care.
The division increases the odds a person will continue health-harming behaviors, over-utilize expensive emergency room visits, recover more slowly from surgeries, and have unnecessary, repeated tests when comprehensive, mental and physical healthcare could help.
But here’s the good news. There’s a growing movement to unify the treatment of mental and physical health. Recognizing behavioral health as a key part of overall well-being, the Department of Health and Human Services Agency for Healthcare Research and Quality is promoting the integration of counselors, therapists, and doctors as a team to coordinate behavioral and medical care. According to the U.S. Health Resources and Services Administration (HRSA),treating mental and physical health together can reduce the stigma of mental illness or abuse problems while providing more cost-effective treatments and improving patient care.
This approach can help people of all ages, including America’s growing population of aging Baby Boomers. People 65 and over are more likely to develop chronic medical and mental health disorders that can benefit from integrated healthcare, notes the National Council for Behavioral Health.
For example, as many as 7 percent of elders suffer from depression, often along with conditions that are more common with advanced age — such as heart disease, diabetes, and Alzheimer’s disease. Research has shown that coordinated care emphasizing behavioral health, such as screening for depression and in-home counseling, can decrease depression and improve the social, physical, and mental health of the elderly.
There are other examples of progress. Nearly 70 percent of HRSA-supported health centers now provide mental health counseling and treatment. All of them provide referrals to substance abuse and mental health services. The HRSA also supports a graduate psychology education grant program that trains psychologists to work with doctors to integrate behavioral health with primary care.
Insurance companies are also recognizing that whole-person care makes sense from both a health and economic point of view. "It's time for a broad, community conversation about the importance of behavioral health and its overall impact on health and wellness. One of the first and most important steps we must take as a society is to overcome the stigma still associated with mental illness and substance abuse so that people who need care are not afraid to seek it,” says John Fallon, chief physician and executive and senior vice president of Blue Cross/Blue Shield of Maine (BCBSMA).
Maine’s Blue Cross has launched several programs to help bridge the gap between behavioral and physical health, including a mobile and online platform that provides members and their families with peer support and tools to aide recovery from substance abuse. A risk assessment tool (AhealthyMe.com) helps members identify excess stress, depression, drug and alcohol abuse, and other common mental health issues. REACH (Recovery Education & Access to Community Health) provides focused care plan development for BCBSMA members and coordinates behavioral health and medical services with community-based support.
Another innovative program, Life Balance, uses one-on-one coaching to teach skills necessary for handling physical and psychological stress when a person faces a serious illness. Ken Duckworth, medical director for behavioral health at Maine’s Blue Cross, recently announced that results so far show Life Balance boosts patients’ ability to cope and also reduces medical costs.
March 04, 2015
Christopher Nystuen, MD, MBA