None of us is as Strong as All of us

What do you think about when meeting with your doctor?  The basic small talk, checking your eyes and ears, or talking about your cholesterol? One thing most people don’t think about when meeting with their doctor is their mental health, but that might be starting to change.  In southeast Michigan, a medical group called “IHA” has started a program in their doctors’ offices called the Behavioral Healthcare Program (or BHP for short).  The BHP’s goal is to make mental health a part of your normal visit to the doctor and decrease the stigma of talking to your doctor about mental health. The program has had large amounts of success in the small amount of time it has been implemented.  It started at the University of Washington around 20 years ago and has been a part of IHA exactly a year as of this November.  I sat down with two people directly involved with the program, psychologist Dr. Pat Ryan and therapist/ Behavioral Healthcare Manager Sarah Fraley to talk to them about their experience so far with the Behavioral Health Program at IHA in my hometown of Milan, MI.

The first thing I was curious about was the day-to-day operation of the program and how it specifically interacts with doctors and patients. Dr. Ryan states that it all starts with the knowledge base of the doctors.  She runs seminars with the doctors teaching them how to identify aspects of mental health in patients.  These seminars are run often so the doctors are continuously learning how to effectively identify concerns and communicate with patients about their mental health. Based off what they’ve learned, the doctors then make referrals with the help of depression and anxiety screening tools. The doctors are the ones on the “front line” of the procedure; once they think they have identified someone who could benefit from the program, they make a referral to Sarah.  After the doctor makes the referral, the Behavioral Healthcare Manager calls the patients and asks if they’d like to be a part of the program, which 98% of patients accept.  Once the patient accepts, Dr. Ryan has access to the patient’s medical charts and history and can look at the “whole person.”  Based off this information she then makes a recommendation on what should be done next for the patient and then Sarah communicates this to the doctor.  Sarah helps with adherence and also helps with steps the patient should take next.  She is continuously re-scoring the patients on depression and anxiety tests and communicating with the patient every week.  Sometimes they will refer patients to full time therapy, but they often have trouble finding therapists or psychiatrists that don’t have lengthy wait-lists.  This led me to ask whether or not a solution to the mental illness crisis might be more psychiatrists, but Dr. Ryan insists this is not the solution.  This would only fix a small piece of the puzzle; the solution would be to implement the Behavioral Health Program or a similar program across the country.  

More therapists and psychiatrists might help with overflow of patients, but would not help with the existing communication gap between them and possible patients. A lot of people simply do not know who  or how to ask for help. One of the main long-term goals of the program is to bridge that gap. The short term goal of the program is to try and figure out the kinks within it. One of the primary problems is that there isn’t a straightforward way to pay for these services as of now.  A lot of insurances don’t have specific guidelines on how much they would cover when it comes to this kind of program. Another problem is just basic funding for the program; they don’t have enough money to expand, but this is slowly changing.  Perhaps the most tragic problem of the program, though, is that they cannot see everyone at IHA that could benefit from their services.  Although they have a lot of patients in the program, they do often have to pick and choose certain people over others based on criteria such as whether or not they have a chronic illness or how old they are.  This is something both Dr. Ryan and Sarah passionately wish they could change, and hope to change it as the program expands.

The long-term plan is to roll the program out in offices all through the country.  Although we may not see this happen for a good period of time, it does seem like this is the direction the program is headed in.  With such high rates of success so far, as well as mental health becoming more and more recognized as being equally as important as physical health, it seems only a matter of time before a collaborative health type program is a part of every doctor’s office.  Hillary Clinton even has a collaborative healthcare model in her medical plan for the country if she is elected, so depending on the outcome of the election, we may see this happen sooner than we think.

One of the most exciting parts about this program is it gives people who don’t wish to approach someone themselves the chance instead be approached simply by having a doctor's appointment. With only 35% of people in America with depression seeking help from a medical professional, this could give part of the other 65% information about resources that would be available to them.  As someone who has had mental illness become a huge part of my life during certain time periods, this possibility fills me with excitement.  The mere existence of the program itself is also hugely promising.  It helps prove that mental health is being taken more and more seriously.

I ended the conversation with Dr. Ryan and Sarah by talking about the state of mental health awareness overall in the United States. Dr. Ryan spoke about how while working in different regions of the country, she noticed that some regions are much further ahead than others.  Fortunately for people in southeastern Michigan, she described IHA and the University of Michigan as miles ahead of other places she has worked in and visited.  Hopefully soon, other regions will start learning from the ones that are further ahead.  Dr. Ryan and Sarah were very helpful and informative about the Behavioral Health Program and gave me hope about the future treatment of mental health in the country.  Collaborative health programs are the health model of the future, for none of us is as strong as all of us.