It's Mental Illness Awareness Week and Wayne Young, senior vice president of behavioral health at JPS Health Network in Fort Worth, Texas, spoke with H&HN about why hospitals should be thinking creatively when addressing behavioral health and what JPS Health Network is doing to integrate behavioral health into primary care. Young is 2016 chair of the American Hospital Association’s Constituency Section for Psychiatric and Substance Abuse Services.
What are some of the innovative things JPS Health Network is doing in terms of behavioral health?
We have a fairly large behavioral health footprint. We have a psychiatric emergency center dedicated to patients experiencing psychiatric emergencies that receives nearly 20,000 visits a year and two in-patient psychiatric facilities with 132 beds. We have six outpatient behavioral health clinics, a walk-in clinic open daily, a school-based clinic, and mental behavioral health specialists. We’ve been working to integrate behavioral health care into our primary care by embedding behavioral health specialists from our larger primary care clinics into our primary care teams. We do universal depression screenings at all primary care visits and have best-practice advisories that notify primary care providers when they’re interacting with someone with an elevated depression score so providers can be mindful of a treatment plan. We’ve had a lot of good outcomes as a result of that increased attention around planning to meet patient needs.
Our psychiatric discharge management program focuses on better transitions from psychiatric to community care settings. Our 30-day readmission predictive tool helps us identify those most at risk for readmission to our psychiatric setting and tailor our interventions by duration and intensity based on that degree of risk. All patients with psychiatric conditions now receive physical health screenings. Patients who take atypical antipsychotic medications often have some adverse health outcomes as a result of their medication. As a result, we now do A1c and LDL screenings on all patients with this medication profile so we can respond quickly to any changes in their health status. We’re really trying to ramp up this idea of early identification of physical health conditions in those with significant mental illnesses.
What are other hospitals and health systems doing in terms of mental illness and behavioral health?
Historically, hospitals and health systems have not always embraced a role in meeting behavioral health needs in communities. Part of that is because of complexity and part is because there used to be state hospital structures and community mental health center structures, and systems felt that some of those needs were already being met. As systems begin to make this movement away from volume toward value-based care and have conversations around increased likelihood of accepting risk, providers realize behavioral health conditions can be a fairly significant driver of cost and poor health outcomes. As systems become aligned with managing the overall health of a population, the realization is they have to become involved in addressing behavioral health concerns.
The conversation around behavioral health needs in every community is increasing as the stigma begins to break down. The conversation is coming from multiple directions, but it all seems to be coalescing right now in a much more meaningful way than it ever has in my 25-year career. It’s an exciting time to have this awareness and discussion, but many health systems are still trying to figure out how to do that. Some are taking an integrated health approach, embedding behavioral health expertise into their physical health oriented mission. Most of the field, I think, realizes that having a completely siloed system that treats the head while the rest of the system treats the body isn’t really going to be effective.
How can hospital leadership better steer an organization in the right direction?
When hospital leaders first start having this conversation they need to look at existing resources in their community. Hospital systems tend to be fairly large entities and tend to immediately think, "What do I need to do to solve this problem?" There’s opportunity in this segment of health care to think about which entities are already engaged in this work, and for systems to partner with them to leverage the technical expertise they have.
One of the things most hospital systems will find is the workforce challenge to this issue — in terms of numbers, and frankly, sometimes even in terms of skill. For example, our community mental health center has two clinics where they bring us in for primary care. At the same time, we don’t have primary substance use disorder services in our system, so we’ve brought in that community health center to deliver treatment services specific to our population. I’ve never been to a community that’s said they have behavioral health completely covered. Every area I’ve been to is always talking about gaps, shortages and challenges they have in their area. This can be overwhelming for health care systems without behavioral health experience.
When those not involved in behavioral health think about behavioral health services they tend to think about traditional treatment models, which are historically delivered by a psychiatrist and maybe a psychologist. But the truth is, I would encourage them not to get locked into the traditional platform of behavioral health service delivery. It might be helpful to begin thinking about nontraditional approaches and multiplier effects that a team can provide. Nontraditional care models such as ED navigators, peer support specialists and recovery coaches can have a huge impact. There are a lot of ways to leverage different disciplines and other professionals, as well as the structures of behavioral health service delivery, that may be not be what many immediately think of.
How do you feel about the future of behavioral health in the U.S.?
I’m optimistic and excited about where behavioral health care is going in our country and in our health care systems. If you asked me that five or 10 years ago, I probably wouldn’t have said that. A robust dialogue is happening in multiple settings. It’s going on in legislative circles, at the top levels of health systems, even with the leadership of the AHA. It’s also happening in other settings, like criminal justice where people are realizing we haven’t been effectively treating mental illness. One of the popular sayings right now is, "There is no health without mental health." The current dialogue is leading us to some very meaningful conversations about how we need to do things differently, how we’re going to fund that care, why it is important, and we’ve begun to recognize the consequences of not delivering that care. The science and evidence around behavioral health is improving and I think we’re moving in the right direction.