Weight . . . check.
Blood pressure . . . check.
Heart rate . . . check.
Mental state . . . check!
The mind is just as crucial as any part of the body when it comes to health and wellbeing. That’s the idea behind Mental Health Integration (MHI) – a system that includes mental healthcare as part of your clinical visit. MHI at Intermountain Healthcare has changed the culture of primary healthcare by standardizing a team-based care process that includes mental health as a normal part of the routine medical encounter.
A little history
Contemporary western medicine is based on a tradition of treating mental health separate from physical health – a tendency to assume that diseases occur independently of social context. This view is called mind-body dualism. But when mental health is treated as separate from physical health, the healthcare experience is often stigmatized and the care process is fragmented. These attitudes are changing, but the fact remains that 45% of aging Americans have a chronic disease, with mental health issues ranking only second to cancer on the chronic disease list. Depression, the most common mental health condition seen in primary care, often occurs with, and compromises, care of other chronic illnesses; yet stigma and secrecy often cause depression to go undetected, undiagnosed, or under-treated.
The situation today
Over the last 12 years, Intermountain Healthcare has developed MHI as a comprehensive team-based innovation for caring for the mental and physical health of patients and their families. MHI is defined as a standardized clinical and operational team relational process that incorporates mental health as a complementary component of wellness and healing for life. The MHI team care process model has spread a new social message of normalizing mental health as a routine part of everyday health exchanges between patients and their doctors and among clinic staff.
MHI involves a team-based approach where complementary roles include the patient and family and are operationalized at the clinic, improving both physician and staff communication. MHI differs from collaborative care models because it is a standardized system in which a key focus is on the primary care providers continuing to provide appropriate levels of mental health care within a high-functioning team. The MHI team includes all of the primary care providers and support staff, in addition to practice managers, mental health professionals, community advocates, the patient, and the family.
MHI continues to be phased into practice at Intermountain facilities. Those clinics that are just starting to form an MHI care plan are called “potential” clinics; those that have a plan underway are called “adoption” clinics; and those that have been practicing MHI for more than six years are called “routinized” clinics – a level that has now been reached in dozens of clinics operating across the Intermountain Healthcare system.
Is it working?
Yes! Studies have shown significantly improved patient outcomes as a result of the MHI care process model. It also leads to cost savings for everybody, as patients treated in MHI clinics are 54% less likely to use expensive emergency room services.
A research study by Dr. Brenda Reiss-Brennan, Mental Health Integration Director for Intermountain Healthcare, shows that when patients can receive effective care at their familiar clinic setting for their mental and physical health, coordinated between their doctor and their broader health care team, their overall functioning in their life is improved and sustained. “Patients in MHI clinics prefer care administered by multiple persons working together with their doctor to address their mental, physical, and family health issues,” Dr. Brennan says. “Patients value a trusting relationship with their doctor who can get to the root of their problem by treating mind and body together and who can work together with a coordinated treatment team.”
The study also indicated that staff members benefit from the team-based approach. It demonstrated that delivering mental health care via a coordinated team using the MHI approach improves staff and patient routine experiences and promotes positive patient outcomes.
And patients can see the difference:
“I visited an Intermountain clinic last summer to get help for my ailing mother, who suffers from debilitating Obsessive Compulsive Disorder to the point that she had dropped to under 100 lbs. I feared for her physical health, but knew it was all a result of her mental health. The physician Mom met with about her severe weight loss instantly coordinated a full team to include someone to help with the mental health problem that was the root of her trouble. The process was smooth and really gave us confidence that she’d get the help she so desperately needed, and everyone treated us with great respect and kindness.” – Mike B.
What does this mean for the future?
“In order to treat the whole person, you have to put the mind and body together,” says Dr. Brennan. And the results speak for themselves: whole person-centered care has been shown to be best for patients, for staff, and for keeping overall costs down. Normalizing mental health as an organized, holistic team process within primary care offers promising results for improving outcomes for patients with chronic disease. And Intermountain Healthcare stands as an institutional role model for MHI.