UCHealth’s approach to patient-centered behavioral health and primary care.
By Jenna Hughes
Mental health is closely linked to physical health – in fact, mental health conditions such as depression increase the risk for many types of chronic conditions including diabetes, heart disease and stroke. Comparably, the presence of chronic conditions can increase the risk for developing a mental health condition, according to the Centers for Disease Control and Prevention (CDC).
“The silos of ‘medical’ vs ‘psychiatric or mental’ health are truly artificial ones – human organisms are fully integrated,” said Hilja R. Ruegg, MD, Program Director of Family Medicine/Psychiatry Combined Training Program and Medical Director of Integrated Mental Health Care at UCHealth. “All aspects of health and well-being interact with one another, contributing to the human experience.”
Despite the role mental health plays in our overall well-being, traditional referral-based behavioral healthcare models are frequently fraught with long wait times and a general lack of care coordination between primary care and mental health care, leading to care fragmentation.
Dr. Megan A. Rock, PsyD, a licensed clinical psychologist and Assistant Professor of Clinical Psychiatry & Behavioral Neuroscience at UCHealth, says that the integration of mental health care within primary care fundamentally increases patient access to care.
“Integrated mental health services can support medical treatment plans and increase self-efficacy for a wide range of chronic medical conditions,” said Dr. Rock. “A central feature of integrated care is the screening of patients for depression at their general primary care visit.”
There are several different mental health care integration models used within primary care settings. Most models target patients in mild to moderate mental health distress and provide them with brief interventions using measurement-based outcomes to track improvement. Other models provide evidence-based treatment options including therapy, medication and more for psychiatric conditions such as depression, anxiety or substance use.
“Through these models, patient-centered care includes physical health, mental health and the connection between the two,” said Dr. Rock. “From setting treatment goals to tracking patient symptoms and outcomes, the mental health service delivered is fully integrated into the primary care treatment plan. It champions the mind-body connection and contributes to both mental health and primary care goals.”
Primary care’s integration with behavioral health includes increasing adherence to health care, such as following up with medical appointments, managing medications effectively, and improving health behaviors like drinking more water, eating balanced and nutritious meals and improving sleep hygiene.
“With increased understanding of psychiatric illness, we are recognizing and learning about the interplay between the biological, environmental and behavioral drivers,” said Dr. Ruegg. “This includes the development of these illnesses and how they play out over a lifetime, akin to how we conceptualize medical conditions – from chronic illnesses to cancers.”
Integrating care
At UCHealth’s primary care clinics, patients with behavioral health needs get connected to care directly through their primary care provider – physicians can either consult directly with experts at UCHealth University of Colorado Hospital, or patients can be referred for appointments through Virtual Visits with a psychiatrist.
Dr. Ruegg said that the foundational elements of successful integrated care delivery include effectively sharing clinical space, support staff, and a unified electronic health record (EHR) system. Familiar with the important connection between behavioral health and well-being, Dr. Ruegg herself heads up a combined Family Medicine/Psychiatry training program.
As the new generation of physicians enters the field with ever-expanding, nuanced knowledge, she says that the complexity of disease demands physicians who are trained to think and care for individuals in wholistic ways.
“Our combined training program is doing that,” said Dr. Ruegg. “We are one of six combined Family Medicine/Psychiatry programs, joining a small number of Internal Medicine/Psychiatry and Pediatric/Psychiatry/Child and Adolescent Psychiatry programs that train physicians to be those kinds of leaders.”
Dr. Ruegg said there is currently a critical need for healthcare leaders who possess not only deep expertise in diagnosis and treatment, but also a sophisticated understanding of how care silos intersect and how to deliver more coordinated, patient-centered care.
“Many within the younger generation are entering medicine with a broader appreciation for the connection between behavioral and physical health and a greater comfort with interdisciplinary, team-based approaches to patient care,” said Dr. Ruegg. “For many early-career physicians, behavioral health integration is viewed not as an adjunct to care, but as a fundamental component of delivering comprehensive, patient-centered treatment.”
Key Takeaways
- Traditional referral-based behavioral healthcare models are often characterized by long waits and fragmented care.
- Integrated mental health services can support medical treatment plans and increase self-efficacy for a wide range of chronic medical conditions.
- The foundational elements of successful integrated care delivery include effectively sharing clinical space, support staff and a unified electronic health record (EHR) system.
- Early-career physicians have started to view behavioral health integration as a fundamental component of delivering patient-centered treatment.