When Nora* went in for a routine foot surgery, she never dreamed it would turn her entire life upside down. Things went well, initially, and she was sent home on schedule. However, the pain medication she was on led to a bowel obstruction, and when her bowel ruptured, she became septic. She spent more than a month in the ICU and had three more surgeries, including one to create a colostomy.
These life changes, especially learning to manage a colostomy bag, left Nora depressed, fearful and anxious. She felt unable to understand or accept what had happened to her. Because she was unable to pursue many of the activities that had previously brought her joy, her life seemed pointless to her.
Nora made a series of appointments with her primary care provider (PCP) – not for her physical needs, but because she desperately needed to talk about what had happened to her. Luckily, Nora received primary care at Mercy Family Medicine in Durango, CO – one of Centura Health’s clinics with an Integrated Behavioral Health program. When her PCP began to understand the depths of Nora’s needs, she was referred to the clinic’s behavioral health consultant, Elaine Blackmer, LPC, DBTC, who partnered with the primary care provider to give Nora the whole health support she needed during a time of immense change and emotional distress.
The Integrated Behavioral Health model places behavioral health consultants within Centura Health Physician Group clinics, working closely with PCPs to address the whole health needs of our patients. The program works to support all behavioral health needs, but maintains a strong focus on depression, screening patients for signs of depression at every visit and incorporating the support of an in-house behavioral health consultant whenever a need is identified.
“In-house behavioral health services mitigate the risk of people falling through the cracks,” said Amber Pace, LCSW, LAC, Director of Integrated Behavioral Health for Centura Health Physician Group (CHPG). “When you’re already struggling, even if you have been referred to see a behavioral health provider, it can be incredibly difficult to take the initiative to reach out. At clinics with Integrated Behavioral Health, our patients don’t have to take that difficult step. We are able to do it for them.”
Integrated Behavioral Health also provides a vital support for our providers. Depression correlates strongly with chronic diseases, which are typically managed by a PCP. Because of this, and because of the significant shortage of behavioral health services in the regions we
serve, the majority of antidepressants are prescribed by physicians without consulting with a specialist in behavioral health – and behavioral health providers’ specialized expertise can provide invaluable insight into identifying the right medication for the needs of each individual.
“There is a significant shortage of behavioral health services in our communities, and frequently our PCPs have to step up to fill that gap for their patients,” said Dr. Krista Ault, Medical Director, Mercy Primary Care. “By offering Integrated Behavioral Health services right in our primary care offices, we are better positioned to address that integral aspect of whole health care.”
From the very first session with Elaine, Nora began to regain hope and a belief that her life might become livable again. She engaged enthusiastically in her therapy, bringing a notebook to write down new ideas and trying new skills as they were offered.
“It wasn’t long before a twinkle began to come back into her eyes, and we saw renewed enthusiasm for life,” said Elaine. “She became more active and reached out to old friends. As often occurs with life’s great challenges, she began to find new strength and wisdom in herself.”
Nora’s PCP partnered closely with Elaine, each keeping the other updated of Nora’s needs and progress. At one point, Elaine identified a need for anti-depressant medication, discussed this with Nora, and an appointment was made to discuss this medication with her PCP. The PCP, Elaine and Nora all attended this appointment to be sure Nora was well informed and to support her in making a medication decision that was right for her.
“We still have some work to do, but her challenges and negativity have improved tremendously,” said Elaine. “She has expressed her appreciation for our Integrated Behavioral Health program many, many times.”
Thanks to multiple grants, Centura Health has now expanded its Integrated Behavioral Health program into 29 CHPG clinics across Colorado, including in the Denver metro area, Frisco, Longmont, Avista, Durango, Pueblo and Cañon City. The program is aimed at short-term solutions, typically seeing patients no more than 12 times in primary care to help manage their symptoms, and then helping establish a longer-term relationship with a behavioral health provider if ongoing support is needed.
This program also works to build bridges with community support services than can help support our patients with a wide range of needs, all of which can impact mental and emotional well-being. With these connections in place, it becomes easier to connect patients with the support services they need in all aspects of life.
“Integrated Behavioral Health came about because there’s a real need in our communities – our Community Health Needs Assessments show that behavioral health is one of the most pressing needs in each of the communities we serve,” said Amber. “Part of supporting that need is making sure we support our patients where they already are.”
*Name has been changed to protect patient privacy.