Treating the Whole Person: Mental Health Integration
By Jennifer Franklin, Chief Clinical Officer, Yoakum Community Hospital
Like many hospitals, Yoakum Community Hospital sees an uptick in patients receiving geropsychiatric services in winter. The holiday season is, therefore, a good time to talk about the mental health needs of this population. With the New Year approaching, it’s also a good time for hospitals to resolve to better address those needs, not just during the holidays but all throughout the year. Yoakum—a 25-bed Critical Access Hospital in rural South Central Texas—accomplishes this through integrated care, which combines primary healthcare and mental healthcare in one setting.
Toward an Integrated Care Model
Many patients with a medical illness have comorbid psychiatric disorders. Medical-psychiatric comorbidity negatively affects outcomes and, for inpatients, it is associated with increased length of stay, rehospitalization and higher medical costs. Treating the whole person is essential for positive health outcomes and cost-effective care.
The New Horizons Program at Yoakum combines mental health services with general medicine to reduce costs and improve outcomes. The program serves patients age 50 and older who are experiencing behavioral, mental or emotional issues. New Horizons provides a mental health assessment and appropriate interventions. New Horizons’ Geriatric Intensive Outpatient treatment program provides group and individual therapy for patients who do not require hospital admission. The Geriatric Inpatient Assessment program provides brief, intensive treatment within the general hospital setting for patients who may be experiencing more severe mental health symptoms. The clinical team consists of a psychiatrist, specially trained nurses and social workers.
The program produces dramatically positive clinical outcomes compared to other care models and shows that a small, Critical Access Hospital can treat psychiatric patients in a local setting. Yoakum presented the program’s results at the 2018 meeting of the American Academy of Geriatric Psychiatry in Honolulu, Hawaii.
The New Horizons Program evolved over 10 years into what it is today. Every hospital needs to start somewhere; Yoakum began with the outpatient program and added the inpatient program later to serve patients who would otherwise need to travel a minimum of two hours for inpatient care. After gaining experience and success with less severe cases, the team received training to treat suicidal patients and now provide them with one-on-one care, with a nurse at the bedside around the clock. Certain rooms on the med-surg unit are specially furnished and equipped as safe rooms for these patients. Both programs meet a significant community need, and the outpatient component is frequently at capacity.
In the beginning, to ensure reimbursement for care, New Horizons served patients 65 and older who qualified for Medicare. The age threshold was later lowered to 50.
Building Awareness and Trust
There are many ways to integrate care. Hospitals can follow an existing model or adapt it to meet their needs. The federal Center for Integrated Health Solutions (CIHS) links to successful models around the country. Short of integration, there are steps that hospitals can take to better serve patients with mental health issues. The first is conducting depression screenings using a Patient Health Questionnaire (PHQ-9) and referring patients for help.
Hospitals moving toward an integrated care model can add a psychologist or social worker to the primary care team. Hospitals preparing to take the next step can consult the CIHS Quick Start Guide to Behavioral Health Integration for Safety-net Primary Care Providers, which includes an interactive decision chart.
Community outreach and education contributed to the early and ongoing success of the New Horizons Program. The team books speaking engagements with local civic and faith organizations, and offers educational programs to nursing homes, hospices, home health agencies as other entities positioned to identify patients with mental health issues. The goal is to become well-known and trusted throughout the community so people know where to go for help when they need it.
It works for Yoakum: In October through winter, when the holiday blues and Seasonal Affective Disorder cause or worsen depression (particularly in older adults), New Horizons program participation swells by about 25 percent.