Psychologists in integrated health care: Family medicine


>>DAN MULLIN: So the Barre Health Center has
been here in the community for more than 40 years now. It is a rural community at least
by Massachusetts standards. Our patients prefer to get their care with us rather than going
into the big city whenever possible. Unfortunately, it is a pretty good drive to any of the local
mental health centers.>>STEPHEN EARLS: We provide care for everything
from prenatal care to end of life care and everything in between. Because of the community
we are serving and the fact that we are in a community with no emergency room nearby
we also have a robust urgent care function. Within family medicine a large percentage
of patients come in with “medical” problems that have a large behavioral health component.>>DAN MULLIN: In the leading ten causes of
mortality for example pretty clearly eight or nine of those are tied directly to behavior.
Behavior is the thing that leads people to get sick or once they get sick they need to
begin to modify their behavior in order to improve the outcome>>RECEPTIONIST: Good Morning Barre Health
Center. This is Carol.>>DAN MULLIN: Family physicians in particular
tend to be very open to having psychologists on the team. I find myself in a lot of really
important ways being treated as an equal. I’m a member of the same physician group
that they are, I receive the same benefits. I’m in the same meetings. I’m involved
in making the same decisions. There is a real opportunities for psychologists to be treated
as equals when they come in to the primary care settings.>>K. AHMED HUSSAIN: It’s not like there
is the group of family physicians and then there’s…>>ALEXA CONNELL: Me as an add on. Yeah.>>K. AHMED HUSSAIN: She is a part of the meetings
every month. She does contribute. And anything behavioral health is channeled through Dr.
Connell. It doesn’t have to be an emergency or a significant illness. Sometimes it could
be somebody who is going through a slump and just needs counseling.>>STEPHEN EARLS: Life is a struggle for a
lot of people. And the more support we can give them the better they do with their life,
the better they do with their chronic disease management, and the better engaged they are.
Having that resource available just makes that so much easier. It makes us more efficient
and provides them with a better level of care.>>PATIENT: This has been my provider for over
20 years. I know the care that I get here. And I trusted it knowing that it was someone
here and that I didn’t have to go into the city or start with someone new.>>DAN MULLIN: When a physician has a patient
walk in and the physician identifies them as someone with an unmet mental health need
or substance abuse need they can come knock on my door or call me on the phone and ask
me to step in.>>ALEXANDER BLOUNT: One of the benefits is
being able to address things while they are a concern. While people are ready to make
a move. When you raise something with your physician and you say “this is really hard.
I don’t know what to do about it or I’m really struggling” the chance to do something
about it is best at that moment. And the chance goes down over time.>>STEPHEN EARLS: Patients come into our health
center and you can’t tell looking at our patients in the waiting room who is here to
see whom. They might be here to see a doctor, they might be here to see a psychologist.
They are not going to a different building for their mental health needs and their physical
health needs. The stigma goes completely away.>>DAN MULLINS: Being able to hand-off to a
psychologist on the team who can maybe spend a little bit longer with them or help build
on what they are doing with the physician can help the physician get to their next patient.>>ALEXA CONNELL: We raise each other’s skill
set. I learn more about medicine every day. You learn more about mental health every day.
It’s enhancing both of our skill sets.>>TINA RUNYAN: I fell in love with primary
care very early in my career as a psychologist. We’re moving much closer to how people experience
their own health and wellness as well as their own disease processes. It’s more than just
the technique of how to deliver care in this way but conceptually how to get everybody
on board working as a team to take care of people in this way. What’s available to me to understand the
person sitting across from me is so much more extensive in terms of having their medical
record. You have so much more context and you have a team to work with.>>ALAN BROWN: A lot of our work is pretty
isolative so to be able to share notes and share ideas and learning is bidirectional.>>STEPHEN EARLS: We can see each other’s
notes. We can communicate within the record through a task or a note pretty readily.>>ALEXA CONNELL: We can make sure the patient
is getting a consistent message from their two primary longitude providers that you can’t
get if you’re not integrated.>>K. AHMED HUSSAIN: When you look at the
value proposition it saves you money in terms of better outcomes, in terms of less ED visits,
less hospitalizations>>STEPHEN EARLS: I think we provide great
care in our practice and I think having behavioral health readily available is a big component
of that.>>K. AHMED HUSSAIN: Good primary care is
good primary care and integrated primary care is really good primary care.


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