Accessing behavioral health care remains a challenge for many of the one in five Americans living with a mental health condition. Through the formation of regional provider partnerships and the use of technology-based psychiatry services, WellSpan Philhaven is making care available when and where it’s needed.
Thomas Fenstermacher, MD, counsels a patient remotely using telepsychiatry services. The technology, which WellSpan Philhaven adopted in 2015, has improved access to psychiatric services by allowing patients and physicians to meet while at different locations.
Nationwide, only 44 percent of adults and less than 20 percent of children and teens with mental health disorders receive treatment, according to the U.S. Department of Health & Human Services. Pennsylvania has roughly 61 percent of the mental healthcare providers its residents need, although overall mental health is improving. From 2011 to 2016, the state rose from 15th to ninth in the nation on Mental Health America’s State of Mental Health report, which ranks states based on mental illness incidence and care access. Despite this progress, counties throughout South Central Pennsylvania continue to identify access to mental health care as a top-five community need through the Community Health Needs Assessment conducted by WellSpan and community partners in Adams, Lancaster, Lebanon and York counties.
When people are unable to receive necessary mental health services, it affects not only their mental well-being, but also their overall physical health. People with mental health disorders have lower life expectancies and utilize more healthcare resources.
“The brain is an organ and is part of the body the same way the heart, skin and lungs are part of the body,” says Dale Brickley, PhD, Senior Director of Innovation and New Service Development at WellSpan Philhaven. “Many elements of physical health have a mental health component. If someone gets cancer, for example, he or she may develop depression, and that depression may interfere with treatment.”
The fact that mental and physical health are often viewed as separate issues and aren’t readily addressed in the same healthcare settings is one factor responsible for patients’ inability to easily receive care, underscoring the need for the integration of behavioral and physical health.
“For numerous reasons — many regulatory and financial — behavioral health care was pulled out of medicine and into its own subcategory,” Brickley says. “If we want to treat the whole person and reduce costs, it makes sense to reintegrate these healthcare components.”
“If health systems are going to promote wellness, they must address all causes of illness. Treating psychiatric and physical ailments together improves overall health outcomes. By caring for the whole person, WellSpan Philhaven is improving the patient experience and the general wellness of the community.”
— Dale Brickley, PhD, Senior Director of Innovation and New Service Development at WellSpan Philhaven
Embedding Behavioral Health in Community Care Settings
When the majority of patients seek care for mental health disorders, they often present at already-overburdened emergency departments (EDs) or primary care offices. By bringing behavioral health professionals into these settings at WellSpan’s acute care hospitals in Lancaster, Lebanon and York counties, WellSpan Philhaven increases the likelihood patients will receive the care they need.
“Our goal is to make behavioral health services more accessible and available to people when, where and how they need them,” says Phil Hess, MHA, Senior Vice President of WellSpan Health and President of WellSpan Philhaven. “We understand that many people show up in the ED or go to their family medicine physician when they’re experiencing behavioral health problems or difficulties. We want to make more immediate services available to not only the people we serve, but also to our primary care and emergency health partners.”
By the end of 2016, WellSpan Philhaven had integrated mental health providers into 21 of WellSpan Health’s primary care practices, and plans are in place to bring providers into more practices during 2017. In some locations, the treatment team features a behaviorist who has completed either master’s- or doctoral-level training. In other cases, nurse practitioners assist primary care providers with ongoing medication management, or psychiatrists are available to perform evaluations and guide the overall delivery of mental health services.
“These providers screen persons for mental health issues and offer counseling, education and additional services as needed,” Hess says. “Over time, our hope is to have behavioral health staff members embedded into each of WellSpan Health’s medical homes.”
In addition to bringing mental health providers into the primary care setting, WellSpan Philhaven has adopted the concept of “reverse integration,” which involves integrating primary care into the behavioral health setting. For example, patients who receive outpatient behavioral health services at WellSpan Philhaven Center for Integrated Healthcare, which is located on North Prince Street in Lancaster, can access primary care in the same office thanks to WellSpan Philhaven’s partnership with SouthEast Lancaster Health Services.
In terms of emergency behavioral health services, WellSpan Philhaven is introducing behavioral health providers into local emergency departments. At WellSpan Good Samaritan Hospital, a provider is on-site during all three shifts, and in January 2017, the same level of care became available at WellSpan Ephrata Community Hospital. WellSpan York Hospital is also staffing a behavioral health unit within the hospital’s ED.
“These behavioral health clinicians help with the transition from the crisis setting to the behavioral health unit,” Brickley says. “They offer level-of-care assessments and help navigate entry into the behavioral healthcare services deemed appropriate. They also coordinate with psychiatrists to ensure ED physicians get adequate consultative services in a timely manner.”
The entrance to WellSpan York Hospital’s new emergency department, which includes dedicated space for providing care to crisis intervention and behavioral health patients
“People can’t achieve optimal health if they are experiencing challenges in body, mind or spirit. That’s why WellSpan Philhaven works as a system of care to promote physical, mental and spiritual health. We are committed to understanding how we can better support our patients, enhancing access to care and having conversations with our provider partners about how we can serve them effectively.”
— Phil Hess, MHA, Senior Vice President of WellSpan Health, President of WellSpan Philhaven
Enhancing Access to More Immediate Care
Many of WellSpan Philhaven’s outpatient behavioral health locations in Lebanon and Lancaster counties offer walk-in availability, allowing patients to receive an evaluation without an appointment. At WellSpan Philhaven Center for Integrated Health and WellSpan Philhaven’s campus in Mount Gretna, triage services are also available, which provide patients access to a psychiatric evaluation within one to five days.
To supplement the availability of community-based and urgent behavioral health care, WellSpan Philhaven also offers a telehealth program that serves new and existing patients, and enables WellSpan Philhaven providers to electronically connect and consult with primary care or ED physicians at locations within the WellSpan Health system.
Patient satisfaction rates for telepsychiatry meet and may even exceed satisfaction rates for in-person services. The American Psychiatric Association considers telepsychiatry a feasible means of evaluation and treatment for a variety of mental health disorders, including depression and anxiety. A 2016 literature review published in World Journal of Psychiatry found that outcomes following telepsychiatry and face-to-face services are, in most cases, statistically equivalent. WellSpan Philhaven employs selection criteria for telepsychiatry to ensure appropriate patients are selected for off-site care.
“What this technology does is allow us to take limited psychiatric resources and use those resources to provide services to individuals in multiple locations,” Brickley says. “Without the telepsychiatry platform, patients may need to travel one or two hours to see a psychiatrist. This platform enables psychiatrists to see patients in multiple offices on the same day.”
For more information about WellSpan Philhaven’s behavioral health services, visit Philhaven.org. To refer a patient for care, call 800-932-0359.