Harvard Medical School's Center for Primary Care uses staff social workers, community resource specialists, and, eventually, telepsychiatry to make mental health part of its healthcare practice.
Harvard Medical School launched an ambitious plan to transform primary care delivery and education four years ago with the opening of its Center for Primary Care. Aimed at developing models of sustainable transformation to help doctors deliver better care under tremendous cost and quality pressure, one of its recent projects is now tackling mental health.
Called the Alice Rosenwald Initiative, the program involves six primary care practices in Massachusetts that are taking steps to integrate mental health services for their patients using a team-based approach. Four of the primary care sites are affiliated with Cambridge, Mass.–based Cambridge Health Alliance, the integrated health system that is also a teaching hospital for Harvard Medical School. The other two sites are affiliated with Boston Children's Hospital. Eventually, the mental health integration initiative will be implemented at all six Harvard-affiliated hospitals as well as 19 practices.
"Mental health disorders are so common that it's really part of the skill set that primary care doctors need to have in order to be a resource and help their patients manage their health," says Russell Phillips, MD, director of the Center for Primary Care. Phillips is also a practicing primary care physician at HealthCare Associates, a primary care practice at Beth Israel Deaconess Medical Center.
Like other primary care docs across the country, Phillips has been on the front lines of seeing patients with mental health issues; however, at his practice, there are mental health treatment options for patients, something he acknowledges is not widespread.
"In my practice, we have four social workers who take care of about 40,000 patients," says Phillips. "They've been historically part of our practice since the mid-'70s; for us, [this] is not a new innovation. Across some of the other practices, it's brand new."
The social workers are considered to be part of the team at HealthCare Associates, says Phillips. If he sees a patient who is presenting with depression or anxiety at a visit, he can give a "warm hand-off" to a social worker who can help that patient quickly.
With social workers on site at the primary care office, Phillips has says he has noticed two significant and positive shifts. First, he says, because of the stigma that is often carried with mental health issues, the patients are more likely to return to a primary care practice setting, where they are familiar with the staff and physicians.
"The fact that it's not marginalized in sending patients somewhere else is important," says Phillips.
Second, because mental health is an issue physicians at HealthCare Associates are dealing with every day, it's not a topic they shy away from. "Because we have treatment resources, all of us are much more open to hearing about mental health issues that our patients are bringing to our practice," he says, noting that doctors who don't have such treatment options may feel stuck because they don't have a way to help.
"When you have no treatment approach, you have nothing to offer, and it's very easy just to not ask questions that are going to frustrate you because you don't have an answer."
In addition to social workers, HealthCare Associates employs community resource specialists, who act as social service coordinators for patients who may need financial, medication, and food assistance.
Even with all of these services, Phillips says one big piece of mental healthcare is missing. "What we don't have in my practice is psychiatry. It becomes a real problem when I want the expertise of a psychiatrist."
That's a sentiment many physician offices and hospitals share because there is a shortage of psychiatrists and mental health providers nationwide.
"That's a big issue right now because in Massachusetts, many psychiatrists don't even take insurance—they're paid out of pocket, and there's a lengthy wait," says Phillips.
Phillips says for the six primary care sites that are integrating mental health into their practices, telepsychiatry will help address the problem of access. Each site is picking its own psychiatrists to work with—an important relationship that needs to be built between each practice and provider, says Phillips. Those psychiatrists will be available for doctor and patient consults.
Another key piece of the care team at these six sites will be population managers who will track patients receiving mental health services. Phillips says the population manager's role isn't to provide treatment but to track the patient's progress, develop a relationship with the patient, and report back to the team.
"This gets to the issue [that] we need to be taking care of patients whether they're in the office or not," says Phillips. "We can't rely on the patient to come back in the office, and especially with something like depression, you have to have a way of reaching out and connecting."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.