Nearly one in five U.S. adults—more than 46 million people—live with some form of mental illness, according to the National Institute of Mental Health (NIMH). Chances are, you know more than one of them. That’s because mental and behavioral health issues take many forms and can vary in severity.
Depression is the most common, with the NIMH estimating that 17 million U.S. adults had at least one major depressive episode in 2017. In fact, a study cited by the Centers for Disease Control and Prevention (CDC) projected that by 2020, depression would be second only to heart disease as a global health burden.
The same study linked depression, anxiety and other mental disorders to physical illnesses including asthma, arthritis, cancer, diabetes and heart disease. Sometimes, a physical ailment causes a mental one. And sometimes, it’s the other way around.
The Mind-Body Connection
“People who have a behavioral health diagnosis tend to have a lot of comorbidities because they are often overwhelmed and don’t take care of themselves,” says Mary Gallo, director of health services at Four Winds Saratoga, an inpatient behavioral health hospital in Saratoga Springs.
Yet, until recently, it was common to treat mental health and physical health separately, with little or no interaction between the two sets of providers. A January 2018 Milliman Research report prepared for the American Psychiatric Association tied this approach to care to medical costs that are two to three times higher among people with both chronic health conditions and mental health or substance abuse issues than among people with chronic health conditions alone. These additional costs were estimated at more than $400 billion in 2017.
However, when care was integrated and coordinated, researchers found that costs decreased by as much as $68 billion, outcomes improved and people made fewer emergency room, hospital and primary care visits.
To be most beneficial, care needs to be coordinated among several providers, including primary care physicians; behavioral health facilities like Four Winds; emergency room and urgent care doctors; specialists; and pharmacists. Keeping everyone up to date requires a health information exchange (HIE) like Hixny, which allows real-time information to accompany or even precede a person from one medical encounter to another.
Treating the Whole Patient
Four Winds has used Hixny for several years. Susan Snowdon, director of information technology, explains that a significant number of the hospital’s patients have complex medical issues in addition to their behavioral or mental health conditions.
Every Four Winds patient is provided with an opportunity to sign a Hixny consent form. The resulting exchange of information through the HIE with other members of the healthcare community has become an important part of ensuring patients receive the best care during their stay and after discharge.
“Sometimes our patients struggle to give us information,” Gallo says. “Some are so depressed they can’t provide much to us. Others, like those with schizophrenia, are really disorganized and have a really hard time answering anything. That’s why coordination and information sharing are important.”
She’s found information in Hixny that has proven “pretty significant” to patients’ care. Gallo uses the HIE primarily to check medications, clear patients for specific types of therapy, find reports from emergency department (ED) visits before admission to Four Winds, and check lab and test results—including prior EKGs to support one of the most common tests Four Winds performs. Since the hospital treats children and adolescents as well as adults, the availability of pediatricians’ records through Hixny has been particularly helpful.
As important as it is for mental and behavioral health providers to access their patients’ comprehensive records, it’s just as vital for these providers to share their own records to ensure smooth transitions of care. Four Winds makes comprehensive discharge summaries available through Hixny as soon as its doctors apply their electronic signatures.
One of the most important aspects of this report may be its accounting of the behavioral health medications prescribed, or adjusted, by the specialists at Four Winds.
“Primary care physicians are generally not experts in the medications that are prescribed after behavioral health diagnoses,” Snowdon says. “They look to us as the experts.”
Sharing Records to Improve Care
New York has recognized the value of coordinating behavioral and physical health care. The 2017 Interim Report to the Office of Mental Health (OMH) Statewide Comprehensive Plan notes that the state is working to create a behavioral health system with integration at the heart of care plans, explaining that “service providers should attend to both physical and behavioral health needs of enrollees, and actively communicate with care coordinators and other providers to ensure health and wellness goals are met.”
Project TEACH (Training and Education for the Advancement of Children’s Health), an OMH program, helps pediatricians whose young patients have mild-to-moderate mental health problems. Jeffrey Daly, M.D., who heads the child and adolescent outpatient program at Four Winds, is among the child and adolescent psychiatrists on call.
“Often a concerned parent will approach their pediatrician, who might identify a problem and want to coordinate care, but not be exactly sure how to do that,” Snowdon says. “Dr. Daly or another Project TEACH child and adolescent psychiatrist will consult by telephone with the pediatrician. The patient isn’t even identified, but the pediatrician has a chance to talk about the symptoms he or she is seeing and maybe get some recommendations. Sometimes, that leads to a referral for an evaluation with a Project TEACH child and adolescent psychiatrist.”