By Domenica Gilbert, Health Disparities Initiative
In discussions surrounding health disparities, access to behavioral health is often left out of the conversation.
Yet the issues are inextricably linked: More than half of patients with a behavioral health disorder don't receive the care they need due to barriers including inability to afford cost of treatment, lack of awareness of treatment options, and stigma. What's more, adults living with serious mental health issues in the United States on average die 25 years earlier than healthy adults, often a result of compromised access to care.
Reducing behavioral health disparities is complex, but one important step you can take is to bolster your primary care offerings. About 59 percent of adults being treated for major depressive episode receive their care from a primary care physician (PCP)—due in part to shortages of behavioral health professionals, especially in underserved communities.
With some help from our colleagues on the Population Health Advisor (PHA) research team, we've identified 3 key strategies you can use to support your PCPs and improve patients' access to behavioral health services.
1. Diagnose your PCPs' top challenges using a 3-step strategy
Baptist Health Medical Group used a targeted, 3-step strategy to diagnose their PCPs' top challenges in delivering behavioral health services.
First, they used an evidence-based framework to identify the specific challenges their PCPs were facing, which categorizes challenges into 3 areas of physician experience: knowledge, attitudes, and behaviors.
Second, they distributed a survey to providers in their group, which evaluated the impact of each challenge. The survey was designed to reduce burden on participants, requesting just "90 seconds" to rate each of the 13 barrier statements.
And third, program champions mapped these top challenges to training opportunities, including short lessons covering topics from the survey, such as attitudes toward depression and knowledge about medication side effects.
A task force of physician leaders called the Empowerment Team then took the lessons learned and developed a behavioral health training program within 3 months, using only one hour per week of each team member's time.
Next step: Learn how you can use a targeted, 3-step strategy to accurately diagnose your PCPs' top challenges.
2. Build your PCPs' communication strategy
It's crucial that your PCPs feel comfortable initiating conversations about behavioral health, even if their patients ultimately require more specialized psychiatric support later on. PCPs are often the first to recognize symptoms and provide a formal diagnosis of behavioral health illnesses.
At NYC Health + Hospitals (NYC H+H), physician champions developed a training program to help their primary care teams master these conversations and improve depression management by leveraging clinical coaches, who are physicians or nurses with experience in the behavioral health field. By supporting staffs' skill-building and training efforts, NYC H+H's coaches have improved PCPs' engagement, self-efficacy, and adherence to care standards. Further, the program has increased screening rates over time.
Next step: Learn how you can leverage clinical coaches to build your PCP team's communication strategy and build a successful depression screening program.
3. Support PCPs with virtual clinical guidance
PCPs may lack the time and resources to successfully support all your patients' behavioral health needs. One answer is to support your PCPs through virtual clinical guidance programs, which offer on-demand psychiatric expertise. For example, JPS Health Network in 2013 launched Virtual Behavioral Clinical Guidance, a service that provides behavioral health consultations and online educational resources to PCPs. And you don't need to break the bank with this strategy: The JPS Network offers this service free of charge.
Next step: Learn more about connecting your PCPs to virtual clinical guidance programs.
For more information on reducing health disparities, check out our free resources available through the Health Disparities Initiative (HDI).