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Adding Up Impact: Catalysts for Innovation

by Molly O'Connell

The following case study is the last of eight stories of nonprofit impact we have published in the past few weeks. These case studies are part of MANP’s Adding Up Impact: Maine Nonprofits at Work report, which will be released today as part of Nonprofit Week.

The Impact

Three in four primary care patients have significant behavioral health needs that either remain unaddressed, or that manifest in a manner that places undue burden on the primary care physician. An innovative new collaboration between Tri-County Mental Health Services and Central Maine Health Care is showing that integration of behavioral health services into primary care practices (PCPs), known as Integrated Primary Care (IPC), is worthwhile both for the provider and the patient.

In the eight years that the program has been in place:

  • 92% of participating primary care physicians affirm their patients are more likely to access behavioral health services when these services are offered within their PCP offices.
  • 90% of integrated primary care patients were able to complete behavioral health treatment in less than three months, as compared to traditional off-site referral based treatment lasting as long 12 months or more.
  • 75% of participating primary care physicians report that integrated behavioral health services reduces the number of emergency department visits for evaluation of mental health and/or substance abuse concerns, a costs savings of approximately $1,233 per admission.
TCMH Faces 2 web TCMH Faces web

The Story Behind the Impact

Increasingly, providers are recognizing the benefits of integrating behavioral and primary care services within the context of the primary care encounter. The majority of patients seen have physical ailments that are affected by stress and trauma or a psychological concern. For example, in the ten most common complaints presented in adult primary medical care settings (chest pain, back pain, fatigue, shortness of breath, dizziness, insomnia, headache, abdominal pain, swelling, numbness) physicians found 85% of these complaints  appeared to have no organic pathology by the end of one year.

Tri-County Mental Health Services (TCMHS) has been a progressive, collaborative leader in service development and delivery for the past 60 years, offering programs to address mental illness, substance abuse, developmental/intellectual disabilities and whole health wellness. TCMHS, in partnership with the Maine Health Access Foundation and Central Maine Health Care, began piloting Integrated Primary Care (IPC) in 2008, and the approach is now fully clinically and fiscally sustainable.

Providing behavioral health in the primary care office allows patients to be seen in an environment that is not stigmatizing, and which allows for essential collaboration between the Primary Care Practices (PCPs) and behavioral health experts.  TCMHS’s integrated approach includes the administration of the Patient Health Questionnaire (PHQ 9), which provides clinicians with concise screening for potential mental health concerns and risk stratification in the event there is a potential safety concern. The PHQ9 is completed by TCMHS behavioral health clinicians at primary care practices as baseline screening for intervention.

The rationale for integration is clear: when the primary care setting is also the behavioral health setting, there is better adherence to treatment as well as better support for the patient who is placed at the center of their care plan and therefore, better outcomes. Offering these types of behavioral health services at  a patient’s PCP appointment results in: shorter treatment times for behavioral health services, an increase in prevention, early identification of and interventions for chronic disease, and enhanced coordination of patient care through utilization of one electronic record accessed by the integrated treatment team. TCMHS’s innovative approaches to integrate behavioral health with physical health are cost-effective and offer the highest quality of care for communities.

Your Impact

We know nonprofits across Maine are strengthening their communities. Help us make sure everyone knows it. Post your own stories of impact via Facebook and Twitter, and use the hashtag #NonprofitsGoodForME.

Sources: Interviews with Tri-County Mental Health Executive Director Catherine Ryder August 1, 2014 and October 6, 2014;
Integrated Primary Care: The Future of Medical and Mental Health Collaboration, Alexander Blount, 1998; Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome, Kroenke K, & Mangelsdorff AD.

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