Even before the COVID-19 pandemic, mental health issues have been on the rise across the nation, but many struggle to access the care they need. Collaborative care -- an approach sown to improve psychiatric care -- combats this issue by integrating mental health professionals into the primary care setting.
Penn Medicine's collaborative care program, Penn Integrated Care (PIC), uses a centralized resource center to facilitate intake, triage and referral management for all patients with mental health needs. A new study, published in the Annals of Family Medicine, suggests that this approach is effective and efficient for meeting the needs of a diverse group of patients with the full range of mental health conditions seen in primary care.
WHAT'S THE IMPACT
Collaborative care has been shown to be effective in connecting physical and mental health. Without a formalized follow-up process and supportive guidance, many in need of mental healthcare may fall through the cracks or receive substandard care.
In January 2018, Penn's department of psychiatry and the Primary Care Service Line launched PIC to increase access to, and engagement with, mental healthcare to improve mental and physical health outcomes. In the PIC model, which builds on other collaborative care programs, the collaborative care team consists of the patient, primary care provider, a mental health provider, consulting psychiatrist and the mental health intake coordinators in the Resource Center.
Penn Medicine encouraged primary care practitioners to refer patients with any mental health symptom or condition for further evaluation, as opposed to only those patients with mild to moderate issues, as is the case in typical collaborative care models. The Resource Center assesses patients by phone, referring them to the appropriate level of care using decision-support software, and facilitates engagement in community-based specialty care.
The benefit of the model with a resource center is twofold: ensuring that patients who need more specialized care are well supported; and alleviating mental health professionals from becoming overwhelmed with assessment and referral activities, allowing them to more efficiently use their time.
Primary care providers in eight practices participating in PIC referred patients with any unmet mental health needs to the program. In the first 12 months, 6,124 patients were referred. They reported symptoms consistent with a range of conditions from mild to moderate depression and anxiety to serious mental illness including psychosis and acute suicidal ideation.
Of those who then enrolled in PIC, the average length of treatment was 7.2 encounters over 78.1 days. Nearly 33% of patients with depression and almost 40% of patients with anxiety experienced symptom remission over the first year of PIC. In the subsequent years since the launch, even more patients have experienced remission.
The researchers gathered feedback on PIC from stakeholders, including health system leaders, PCPs, mental health personnel and patients, and all viewed the program favorably.
Stakeholders found that PIC took the onus of navigating community mental health treatment off the shoulders of providers and patients, and created a streamlined referral process that enabled more patients to access needed care. Further, they reported during qualitative interviews that they found PIC to be an efficient and cost-effective way to coordinate and risk-stratify primary care patients' mental health needs when compared to services as usual.
Of the eight practices that initially implemented PIC in 2018, all eight continue to implement the program, demonstrating 100% sustainment. And due to the program's success, expansion is in progress; PIC has recently expanded to three new primary care practices, and 10 to 15 are expected in the next year.
THE LARGER TREND
A spotlight has been shone on mental health services during the past year, and with good reason: With the COVID-19 pandemic creating an isolating effect for millions of Americans, people need it.
Telehealth has helped to connect people to qualified clinicians, but now the question remains how to retain and expand access to care for those seeking behavioral healthcare. It's a pressing issue, with a recent study showing that mental health services were the most common use of telehealth during the early days of the pandemic. In the midst of skyrocketing depression rates, the findings show that more patients used telehealth for behavioral rather than physical conditions.
This shift to telehealth, particularly video, was enabled by time-limited, regulatory changes related to reimbursement, privacy standards for telehealth technology, and licensure. Lessons from utilization during this period can inform policy for the post-COVID-19 era.