photo by: Contributed

LMH Health's main campus at 325 Maine St.

Mental health needs continue to increase within our communities and patient populations. The National Institutes of Health estimate that more than one in five adults in the U.S. live with a mental illness. Over the past year, LMH Health has implemented a care model new to the health system to better support patients – Collaborative Care.

“National data indicates that Collaborative Care results in a 50% reduction in depression and anxiety symptoms. Using this model allows us to focus specialty psychiatry care on higher acuity and complex needs,” said Sandra Dixon, Behavioral Health Integration director.

Before we dig in, let’s define Collaborative Care. It is an evidence-based model developed by the University of Washington to treat common mental health conditions in an integrated fashion within primary care.

“The Collaborative Care model is used in many other states, but it’s new to Kansas,” Dixon said. “The Kansas Department of Disability and Aging Services received a grant to implement in five locations, which are rural health clinics or federally qualified health clinics, but LMH Health was the first one to try with freestanding primary care.”

Why did LMH Health turn to the Collaborative Care model? Dixon said that patients with co-occurring depression and anxiety challenges sometimes struggle to meet their basic health needs and aren’t managing either one of them.

“It’s really difficult to get into a psychiatrist or therapist because wait lists are long and sometimes patients don’t know how to access care, so they don’t take action. We also heard from primary care that they struggle to serve these patients,” she explained. “Adding more psychiatry or traditional therapy at LMH isn’t feasible from a service or financial perspective, so we’re focusing on this model that serves as a bridge.”

Matthew Leiste is the Behavioral Health Navigator who serves as that bridge connecting the patient with care.

“We want to give patients the tools they can use to manage their behavioral health challenges,” he said. “This program gives them access to cognitive behavioral therapy, resources and tools so that when they’re done with me after three or four months, they have the tools to manage their symptoms whether or not they follow through with other resources.”

HOW DOES COLLABORATIVE CARE REALLY WORK?

Primary care physicians drive this model. They make the decision to recommend Collaborative Care to the patient and are involved in the recommendation to discharge. Physicians are the drivers.

“Collaborative Care is a team approach. The patient, their primary care provider, a consulting psychiatrist, and I work together. The approach varies patient to patient and can include medication in addition to behavioral health interventions,” Leiste explained.

To be eligible, LMH Health primary care patients age 18 and older are screened using the PHQ-9 and GAD-7 questionnaires, which use patient-reported information to measure depression and anxiety. Patients whose screening results suggest they are experiencing moderate depression or anxiety, and provide written consent to participating in the program receive a referral. Leiste contacts the patient within a day or two to start the process.

“I then meet with the psychiatrist and they might make recommendations about medications or other interventions. I may have recommendations about connections to community-based resources,” he said. “I share that information back with the primary care clinician because they decide the course. The consulting psychiatrist doesn’t prescribe, they only recommend.”

WHAT DOES THE DATA SHOW?

Through early December, Dixon said there have been 374 patients referred to Collaborative Care by 38 LMH Health primary care clinicians. More than half enrolled in the program.

“The outcomes are good, with 67% of participants completing the program. In the behavioral health world, that’s fantastic,” she said. Patients who need long-term psychiatry or therapy are also using this program as a bridge to get to the next level of care.”

While these numbers are showing positive results, they’re also helping clinicians learn which patients receive less benefit from Collaborative Care. Dixon explained that includes patients living with cognitive impairment or who are on the autism spectrum.

“The model is Cognitive Behavioral therapy (CBT) based, so it can be hard to teach, practice and implement skills when you’re living with cognitive challenges,” she said.

IMPACT AND OUTCOMES

Dr. Matthew Bihlmaier, an internal medicine physician at LMH Health Primary Care – 6th and Maine, said that Collaborative Care has been a great benefit – especially as the number of patients reporting mental health concerns continues to increase.

“The waitlists at some behavioral health clinics can be months long,” he said. “This provides my patients with access to care within a couple of weeks. They’re able to begin receiving comprehensive mental health treatment to address issues that are having a significant impact on their lives.”

Amy Baker is an APRN at LMH Health Primary Care – South Iowa Street. She sees patients who need more help than she can provide in the scope of family practice and appreciates the additional support to get patients the care they need.

“It takes a lot of trust to talk about your mental health,” Baker said. “Patients have a relationship with their primary care provider already. Getting care in this setting can help reduce the stigma and normalize mental health care.”

It’s not just patients who benefit from the Collaborative Care program. Dr. Bihlmaier explained that it’s also a benefit for the community.

“This program adds a valve to help release the pressure on a behavioral health system that continues to see the need increase,” he said. “This may be the first step toward continuing to receive longer-term care, and we’re able to intervene early. You’re getting a great start from a team that knows you and is already invested in your care.”

Baker encourages patients to participate in the care model. She poses this question: If you’d use other specialties like neurology or dermatology, why not Collaborative Care?

“Mental health is an issue that needs to be addressed. We’ve got a real opportunity in a primary care setting to use telehealth visits and reduce barriers to care, including transportation needs and long wait times,” she said. “Having access to effective treatment benefits patients and in turn, helps create a stronger, more resilient community.”

Autumn Bishop is the marketing manager and content strategist at LMH Health, a sponsor of the Lawrence Journal-World health section.