Photo by Alyx Chandler.
Brandy Wells, a social worker at St. Vincent’s Primary Care Clinic in Hoover, holds the PHQ9 form given to each patient to check on mental health.
When implementing most new mental health approaches, St. Vincent’s Administrative Director of Behavioral Health Kimberly Wigley said, the hardest part is often at the beginning, getting people familiar and on board.
In April 2016, the Community Foundation of Greater Birmingham (CFGB) partnered with St. Vincent’s Health System to fund a grant for the Collaborative Care Clinic, which created Alabama’s first integrated care model.
An integrated care model operates by training associates and physicians about anxiety, depression and other mental illness warning signs so they know when to refer patients for mental health care. The model requires primary care physicians to check in with patents about mental health needs, in addition to physical health needs.
What makes the integrated model different than previous health care models, Wigley said, is that it places an on-site social worker in a primary care clinic to integrate mental health diagnosis and prescriptions to patients on the same day of their doctor visit if they show a need.
This model was implemented in St. Vincent’s East Behavioral Health Outpatient Clinic first, and then in Hoover at the St. Vincent’s Primary Care Clinic.
“You hear a lot about integrated medicine across the country and it’s not as commonplace here in this area, but we felt like it was a really good place to utilize the psychiatrists we were using in our outpatient clinic to provide the support and recommendations to the patients in the Hoover clinic,” Wigley said.
The national AIMS (Advanced Integrated Mental Health Solutions) Center model places a licensed social worker who does psychotherapy right down the hall from physicians. Whether it’s a new patient or someone coming in for their annual physical, every person must take a moment and fill out a questionnaire called a PHQ9, a screening to help identify anyone who might have a mental health need. The questionnaire results are looked at immediately, Wigley said. If something needs to be addressed, they head over to the social worker’s office, down the hall in the same building, “which is much more convenient for the patient.”
The model’s main objective is to conveniently offer mental health care through social workers in primary care facilities. Wigley said research has shown this to improve mental health outcomes, meaning more people are proactive about seeking treatment for their mental health.
The model also lowers treatment costs by reducing co-pays, as patients don’t have to visit a second facility or find a provider who may not take their insurance.
As of the beginning of 2019, the national AIMS Center model, created by the University of Washington, is now offered in over 1,000 outpatient clinics nationwide, Wigley said, including the Hoover primary care clinic.
Photo by Alyx Chandler.
The exterior of St. Vincent’s Primary Care Clinic in Hoover.
“The patient is then able to do everything right in that same space and they feel very safe and very comfortable, and the social worker and psychiatrist then enters all the notes on these patients into a joint record so that the primary care physician has all that information right then about what’s going on with their patient,” Wigley said.
St. Vincent's Foundation President Susan Sellers said about 50 percent of patients who get a mental health referral from primary care physicians never follow through with it, which leads to more mental health problems for them in the future.
“We see all these patients who see their primary care physician, and [we] see they have a diagnosis of anxiety and depression or whatever, but about 50 percent of them will ever really follow up and seek care from a mental health provider,” Sellers said.
Finding a mental health provider can often be difficult and time-consuming, Sellers said, which also discourages people from dealing with mental health care outside of a primary care setting. Collaborative care makes it more accessible, Sellers added, and simply adds an additional check-in with doctors.
Due to “the severe lack of psychiatrists in our area and across the country,” Wigley said, patients complained that when they called local mental health facilities, they would usually have to schedule appointments two to three months away because the facilities were heavily booked up.
Many of those same people, she said, would get discouraged or think it was too much of a hassle to continue. With the integrated model, patients are able to walk down the hall on the same day as their appointment St. Vincent’s Primary Care.
Since they began the program in 2016, Wigley said it’s becoming more commonplace and they’ve seen patients “more interested in getting help,” especially those who were formerly too embarrassed to seek out a mental health care provider.
Like all other parts of the primary care setting, they also have review systems in place for patients to share their thoughts about how to make the collaboration better.
“I think there’s a lot more public acceptance to the fact that so much of the population suffers from depression and anxiety, and it goes undiagnosed and untreated. It affects us in so many different ways,” Sellers said.
Even though primary care physicians are able to prescribe medications for anxiety and depression, they haven’t always had the time and specialties to walk through mental health needs with a patient, Wigley said. Sometimes mental health needs can manifest in physical ways like headaches or tiredness, for example, she said, and it takes a little longer for doctors to get to the bottom of what’s going on with a patient.
Wigley and Sellers said they are hoping for the collaborative care model to become a permanent fixture in all St. Vincent’s clinics and hopefully throughout the state, so that it is able to help more patients.
The partnership with the collaborative care clinic is set to continue at both St. Vincent’s locations through 2020 and possibly longer as new grant funding is secured.
Learn more about the work of the Community Foundation at cfbham.org.
