Mental health is a concern for everyone. The Centers for Disease Control and Prevention (CDC) predicts that more than 50% of the people in the U.S. will have a mental health condition at some point in their lifetime.1 Defined by the CDC, mental health conditions are characterized by alterations in thinking, feeling, mood or behavior associated with distress or impaired functioning.2 Additionally, nearly one in five children in the U.S. experiences a mental, emotional or behavioral disorder such as ADHD in any given year.3 The National Institute of Mental Health (NIMH) indicates that primary care settings provide about half of all mental health care for common psychiatric disorders such as anxiety, depression, ADHD, behavioral problems and substance abuse.4 This creates a substantial burden on primary care and pediatric practices already trying to keep up with insurance company paperwork, referrals and documentation for accreditation organizations.
Patients with mental health diagnoses typically have difficulty keeping up with medications and treatments. Statistics show that when a referral is made to a mental health provider, only half of the patients will follow up and make the first appointment.5 For these reasons and many others, patients with mental health issues are less likely to receive effective mental health care when provided in a primary care setting.
One way to alleviate some of the load for the primary care provider and enhance patient care is to integrate a health care manager into the practice. This team member, typically a registered nurse or licensed social worker can work together with the provider and patient to develop a care plan. The care manager can also serve as an effective intermediary with the mental health specialists, ensuring that the appropriate screenings are completed, and that medication and treatment recommendations are being followed. A supportive care manager has knowledge of community resources to help the patient and family alleviate roadblocks related to financial issues, housing concerns or other identified personal dynamics that may affect medical care.
People with serious mental health issues also experience more medical comorbidities such as obesity and diabetes, sometimes due to medication side effects. These types of concerns further underscore the benefit of additional monitoring of this population by an effective health care manager to ensure that all aspects of their health are being addressed.
As an example, a recent pediatric patient was having severe behavior issues that were going unresolved for a variety of reasons. As a care manager assigned to a pediatric practice, I was asked to meet with this young patient and his mother to assess the situation. The mother was very overwhelmed and frustrated. Over the course of several office visits and phone calls, we were able to review the child’s current medications and previous interventions to determine what was working and what was not. Also, during these conversations, other needs and roadblocks to treatment were uncovered such as transportation issues to and from appointments. I also noticed that the mother was having a hard time navigating the mental health appointments and understanding what follow through was necessary.
All these issues led to stalled care. In my role as health care manager, I reached out to the mental health specialists for this child and obtained the requested documentation to move forward on required testing. I was able to share this information with the provider and the mother to formulate a plan. As a result of the increased time I was able to spend with this patient and his mother, their situation drastically changed. The child started responding to newly-prescribed medications and some of the personal roadblocks were removed allowing the mother to get to scheduled appointments with mental health specialists. Most importantly, the child’s behavior and mental health has improved, and he is now able to attend school.
This is just one of many examples of how a health care manager can make a positive difference in patients’ lives while also lifting some of the burden off primary care providers. The full value of an effective health care manager can be seen in reduced costs of care, increased quality scores, patient satisfaction and ultimately a healthier patient population.
1 Centers for Disease Control and Prevention. Learn About Mental Health. 2018. https://www.cdc.gov/mentalhealth/learn/index.htm
2 Centers for Disease Control and Prevention. Learn About Mental Health. 2018. https://www.cdc.gov/mentalhealth/learn/index.htm