In this chapter, we consider 3 issues that can improve your conduct of mental health care: working as a team, referral, and personal awareness. The first 2 issues consider how best to get help from others by enlarging your care team, while the latter addresses what you can do to enhance your own success in conducting effective mental health care.
In this section, we explore ways in which primary care health providers can incorporate other team members to maximize mental health care in primary care settings. As we discuss the benefits of collaborative care models (CCMs), we’ll focus on how you can extend this care beyond the boundaries of a single practice and what an individual practice can do, based on principles developed in patient-centered medical homes.
Working As a Team Within the Primary Care Office
Some practices have formal CCMs. CCMs include mental health specialists (usually a psychiatrist) embedded within or external to the practice. Although there are many models of CCM,1 in the generic one, the psychiatrist, usually off-site, supervises mental health care by consulting with the second component of a CCM, an onsite (full-time or part-time) care manger, hopefully with some mental health care training. Guided by the psychiatrist on a weekly or biweekly basis, typically by telephone, the care manager provides day-to-day mental health care in consultation with the primary care provider who largely functions to write prescriptions advised by the psychiatrist.2,3 Studies have found that these models improve outcomes for depression as well as chronic medical conditions like diabetes mellitus.3-8 Unfortunately, reflecting the dearth of psychiatrists, there has been little widescale penetration into US care when viewed from a population perspective. If you are among those fortunate to have a CCM team available, make use of them not only for your patients, but also as an educational resource.
Nevertheless, because most practitioners to not have access to a CCM team, we need to think about ways that you can construct and mobilize your own core teams based on the chronic care model that guides collaborative care.9 This means enlisting your partners and staff in your own offices to fulfill at least some of the functions of CCM team members. After all, these are the people interacting with your patients at check-in, by phone, during visits, and when you are out of town. The skills and roles will vary among different practices, from highly developed patient-centered medical homes to traditional primary care offices.
Identifying core team members can help in several ways with the ongoing care of your patients with mental health disorders. These benefits include:
Identifying high-risk patients
Identifying problematic and/or positive behaviors
Reinforcing care plans
Coordinating care outside of office visits
Facilitating contact with community resources