Primary care: Now, for your body and your mind

They’re not just for aches, flu shots and checkups anymore. Primary-care practices are integrating on-site behavioral health resources, becoming one-stop shops for comprehensive treatment of both the body and the mind.

“Your mental health affects your physical health, and vice versa,” said Dr. Catherine Harrison-Restelli, Sheppard Pratt psychiatrist and Greater Baltimore Medical Center psychiatric department chair. “For someone with depression, for example, it may be harder to make good choices like eating healthy food and keeping up with medications. But, if the depression is treated, the patient gets better both emotionally and physically.”

After a successful pilot program in 2015, the Sheppard Pratt Integrated Behavioral Health at GBMC Health Partners collaborative partnership rolled out in November 2016, embedding full-time behavioral health specialists in nine of GBMC’s 10 primary-care practices, along with visiting Sheppard Pratt psychiatrists and substance use counselors from Kolmac Outpatient Recovery Centers. Evidence-based screening tools indicate a 52 percent reduction in anxiety and a 36 percent drop in depression among the 2,000 patients seen since the program launched. Dr. Harrison-Restelli points out that 86 percent of GBMC patients scheduled for behavioral health appointments through the program actually show up, compared to the national no-show average of 50 percent.

In the past, patients have often had to initiate their own treatment for mental health issues such as depression, anxiety, insomnia, stress and substance use by seeking referrals to community-based providers. Many never make it into treatment at all, frustrated by long wait times for appointments and out-of-date directories. A general lack of communication between primary-care doctors and behavioral health providers traditionally makes follow-up difficult for those who actually get in to see someone.

“Patients were often left on their own to make appointments, and to make sure the provider is accepting new patients and will take their insurance,” explained Dr. Robin Motter-Mast, a physician and director of primary care at Greater Baltimore Medical Center. “Embedding behavioral health resources into the primary-care practice gives patients much faster, more convenient service, often the same day.”

Other advantages of making mental health services available at primary-care settings include a more holistic approach to patient care, access to a built-in network of specialty behavioral health resources, and the comfort of being treated in a familiar setting.

“It also helps keep patients out of the hospital,” Harrison-Restelli added. "Many bounce in and out of ERs thinking they’re having heart attacks, when they’re really experiencing stress and anxiety. This way, we can give them educational tools and information that can save them time and money spent on unnecessary tests, procedures and hospitalizations.”

GBMC and Sheppard Pratt providers benefit from the partnership as well. A registry system streamlines administrative aspects, making the entire patient record available in one location for easier tracking. Both Motter-Mast and Harrison-Restelli hope the concept of integrating behavioral health into primary-care settings will become more widespread across other organizations and fields.

“It’s already been a huge success for our primary-care practices,” said Motter-Mast. “Our current setup is really intended for short-term therapies and interventions, though. In the future, it’s going to be important to facilitate deeper relationships with community-based mental health and substance use providers who can offer longer-term solutions.”