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No wrong door

Lisa Decker, patient of Eastern Maine Medical Center’s Family Medicine Center and Residency, decided it was time to get help for her depression. “You get to a point where you might think you are going to do it on your own, that you’re just sad and you’re just going to be able to get through it—next week I’ll feel better. Then, the next week comes and you don’t feel better. So, then you say, ‘Who can help me?’”
Help is down the hall
EMHS members, like Eastern Maine Medical Center, know that offering services like medical and behavioral health together under one roof within primary care practices—integrating them—leads to better care for our patients. Lisa’s provider, Karen Farris, DO, said, “I was able to talk with her about her interest in [getting help with her depression] and then provide that direct transition, we call it a warm handoff, to a behavioral health provider here in the office.”
“What happens in primary care sometimes is that it will be where patients first tell their story of depression, anxiety, persistent mental illness, loss, substance abuse, or past traumatic events,” explained Omm Stilwell, licensed clinical social worker (LCSW), Acadia Healthcare. However, even though mental health and substance abuse issues are often linked with physical health problems, historically they are treated separately.

Omm spends her days working directly with patients at Inland Family Care on the Concourse and Inland Women’s Health Care, both located in Waterville. She and others in her field are part of Acadia Healthcare’s Integrated Behavioral Health program that supports outpatient practices—within and outside of our system—to improve access to behavioral health expertise, which includes substance use disorders, mental illness, and other mental health issues that can affect functioning and general health. The program embeds licensed clinical social workers (LCSWs) and/or psychiatric mental health nurse practitioners (PMH-NPs) into outpatient practices throughout our system as a part of the overall care team.

Jesse Higgins, RN, MSN, PMH-NP, Acadia Healthcare director of Integrated Behavioral Health, explained how the program supports EMHS’ strategic vision to improve and simplify access to care for our patients. “We’re using the ‘no wrong door’ approach that challenges past behavioral healthcare delivery models. It means when you come into any EMHS practice, you have come to the right place—we will find you the support you need.”

Michael Workman, PMH-NP, is another provider who works for Acadia Healthcare. Like Omm, he sees patients at Inland Hospital’s practices, only he does so via telemedicine—Michael actually lives in Indiana. This service allows even remote corners of Maine the ability to access behavioral health services from providers that local member organizations may not be able to recruit otherwise. “It is really no different than someone sitting across the table from me,” Michael told us. “The only difference is the physical contact of shaking someone’s hand upon meeting them. I’ve had people say, ‘I’m not sure about this,’ at the beginning of an appointment and later saying something like, ‘Yeah, this is pretty cool—this worked well.’”

The Integrated Behavioral Health program has been met with an overwhelmingly positive response. “Access to behavioral health expertise is our top priority,” Jesse told us. She added that practices use acute appointment openings and inform patients who are waiting for an appointment as to when there are openings. Practices also notify primary care providers when there are cancellations and Integrated Behavioral Health provides provider-to-provider on-call coverage so there is always a behavioral health specialist available during business hours.

The employee experience
Patients are becoming used to their primary care providers collecting information about the social aspects of their lives that affect health like housing, substance misuse, and food security along with their heart rate and blood pressure. However, as practices ask these important questions, Jesse recognized a need to help clinical staff feel more confident about helping patients who have coexisting mental health and/or substance misuse problems as well as physical symptoms.

“Some clinical staff felt intimidated by issues brought up in the exam room like a patient’s IV drug use, past abuse, paranoia, PTSD, or trauma,” Jesse explained. “Sometimes it can be as simple as, ‘What do I do when someone starts crying? Do I comfort them? Say nothing?’” These types of intense interactions can be emotionally demanding situations and put staff at risk for experiencing compassion fatigue. “We provide tools to help staff care for the patient while also protecting themselves by practicing self-care.” Jesse is now hitting the road and visiting practices throughout the state to educate and empower clinical staff with information and scripting to create positive outcomes for patients and staff alike.

As employees and patients throughout our system benefit from the continuous rollout of this integrated care model, Jesse told us there are even bigger plans in the works. “We are excited to be in development of a behavioral health service line that will provide the same level of consistent, quality behavioral healthcare throughout all levels of our member organizations. We are working together as a system to provide excellent care to all patients, regardless of which door they walk through.”