September 18, 2019

Primary Care & Behavioral Health – Where Heart and Head Now Meet

An increasing number of Americans suffer from mental health conditions such as anxiety, depression, and substance use disorders—so many, in fact, you can now compare mental health diagnoses with the number of people diagnosed with diabetes or yearly flu infections in the United States. Given the prevalence of these mental health conditions, Partners HealthCare has been rethinking the way patients are connected with mental health professionals. By integrating behavioral health services into primary care offices, these specialized health care professionals can now support patients with mild to moderate behavioral health concerns in the same setting where one would address diabetes or a case of the flu.

In nearly all primary care practices across the Partners system, providers have access to specialized team members called Behavioral Health Support Specialists (BHSS). The behavioral health support specialist is not a therapist. They usually have a clinical background in social work or psychology which helps them act as a knowledgeable guide for patients with mental health conditions. They assist patients in navigating their care, as well as provide resources, set goals, and address immediate behavioral health needs.

Connecting to Patients in Primary Care

Idelsy Infante (pictured above), a BHSS at Pentucket Medical Center, a member of the Partners Community Physicians Organization (PCPO), explains that some of the most common ways she helps patients include making sure a patient is taking new medications as directed, setting goals to decrease symptoms (like starting regular exercise or practicing meditation activities before bed), or helping them find resources beyond their primary care office – like a therapist or substance use program. She is an educator, coach, and support system to help keep patients accountable. But often, she’s just there to lend an ear.

“Some people express that just talking about their issues makes them feel better, having somebody to listen,” she says. “Knowing I helped them gain an insight or that I could be a support, helping them in that small way is really rewarding.”

Primary care providers refer patients to behavioral health support specialists either in person (usually after an appointment) or by messaging them in the electronic health record system, Epic, for a follow-up and enrollment in the Collaborative Care program, a team based approach for mental health treatment. After the initial assessment, the behavioral health support specialist checks in with the patient every two weeks, either over the phone or in person. The ideal time frame for a BHSS intervention is around six months, but if it’s apparent they need more time than that, the patient may need a more long-term support like a therapist, psychiatrist, or outpatient program.

Dr. Sitzer, a primary care physician who works with Infante at the Pentucket Newburyport practice, explains that Infante is his “go-to” for any patient with a mental health need. Her specialized background enables her to navigate the complex mental health system with seemingly too few mental health providers and long wait times to get into programs.

“It’s really challenging to find these resources for patients,” says Dr. Sitzer. “It’s really an entire universe in and of itself.”

A Holistic Approach to Patient Care

Yvette Lawhorn, a behavioral health support specialist at Charles River Medical Associates, also part of the PCPO, believes the integrated approach to behavioral health is not only convenient for patients, it helps the primary care team get to the root of patients’ issues. The BHSS connects with patients in the primary care office, which means they also have access to the patients’ medical records, thus creating a more robust picture of their needs. This can help them identify how medical conditions could be contributing to depression or anxiety; or how their mental health may be impacting their medical needs.

“It goes both ways—it’s holistic in a sense,” says Lawhorn. “Whereas I feel like in traditional outpatient therapy the therapist is not necessarily asking you [the patient] about your diet or if your diabetes is well managed. It’s a whole new world to mental health.”

“For us primary care providers, we deal with such a variety of things,” says Dr. Sitzer. “The more tools and resources we have to care for our patients—it’s always a plus. Obviously, our behavioral health support specialists are definitely, definitely a plus.”


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