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UT Health NE providers merge mental health care, primary care

Tyler Morning Telegraph (TX) - 7/6/2015

July 05--On a recent Thursday morning, Dr. Ryan Menard's first patient admitted having suicidal thoughts.

A counselor spent time with the patient and worked with Menard to explore a course of treatment.

This is the norm for Menard, who said the majority of the patients he sees have some sort of mood disorder or mental health issue.

As an assistant professor of family medicine at UT Health Northeast and associate program director for the family medicine resident program, he usually sees about 40 patients a week while also supervising resident physicians.

"Just about every day we'll see someone severely depressed," Menard said. "We can oftentimes grab one of the behavioral health colleagues of ours and see the patient right then and there and get a counselor to assist us with mental health needs."

UT Health Northeast providers, through the behavioral health integration program, unite mental health professionals and physicians for patients who have underlying mental health issues. It calls for physicians to be more aware of a mental health issue in the clinical setting, so they know which questions to ask, how to evaluate and refer for further treatment if needed. Staff, including psychologists, doctorate-level psychology interns, social workers and licensed professional counselors, work closely with medical providers there.

Every patient gets a mental health screening. This includes a nine-question survey asking about their sleep patterns, appetite, stress level and if they've had thoughts of hurting themselves.

"The theory is more and more we're seeing how mental health and physical health are one in the same," Menard said. "They are not mutually exclusive. What affects one will affect the other."

UT Health Northeast is the anchor for the Medicaid 1115 waiver for Northeast Texas Regional Health Care Partnership, covering 28 counties. This includes tackling the integration of behavioral health with routine care.

Merging mental and physical health care also reduces costs, a critical issue, as medicine shifts from fee-for-service to attention to quality, efficiency and prevention.

"This is actually a delivery model that's moving us on into the 21st century in terms of the major changes occurring in the health service delivery," said Dr. Charles Walker, a clinical psychologist at UT Health Northeast.

MERGING TREATMENT

Generally, there long has been separation of mental and physical health in modern medicine, with doctors, psychologists and psychiatrists working alone without ongoing dialogue about a particular patient.

"For many years in health care insurance, unless you exercised both parts of your insurance plan, you may not have known that for years the behavioral health or mental health part was many times administered totally separately than the medical portion," Walker said. "Very often policies were written with a separate deductible and different kind of caps."

He believes that separation is coming to an end.

"Part of that has to do with people's realization that it's not only an irrational way of viewing things but it also had some real cost associations with it in terms of not realizing how much impact behavioral health issues could have on physical health," Walker said.

Doctors say it's important for patients to recognize and seek treatment for depression or signs of a more severe mental illness, as they are less likely to take good care of themselves.

Studies have found people with serious mental health problems on average die 25 years earlier than the general population, primarily due to treatable medical conditions.

Depression has a significant impact on chronic illnesses. For example, patients with diabetes are at an increased risk for cardiovascular disease, which may lead to heart attacks or strokes. The disease can be debilitating, which brings stress to the patient.

"It can be a frustrating illness, especially if you can't get a handle on it," Menard said.

Depression also affects cardiovascular surgery outcomes.

"People who have depression are at an increased risk for a number of medical conditions and heart disease is one of those," Walker said. "Depression is a common post-operative complication in cardiac surgeries, especially for males. It's also a post-event complication after people have had a heart attack."

By integrating mental health treatment, doctors may reduce a patient's number of office visits and medication being prescribed.

Health professionals say one of the greatest barriers in treating mental illness is stigma, particularly patients who live in rural areas. Merging mental health with primary care may help reduce that stigma, as a patient can address both in one visit.

"The first message is it's OK," Menard said. "It's very common and OK to talk about it. If you think you have a problem, seek care. There are options out there."

@cdillard_TMT

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