Treating Mental Health Issues in Primary Care Settings

To improve mental health services in the Carolinas, The Duke Endowment awarded nearly $6 million to help integrate mental health with primary care in North Carolina and use telepsychiatry for crisis mental health care in South Carolina.

A unique collaboration in South Carolina is helping address mental health needs.

Challenge

Experts estimate that approximately 50 percent of patients seen for primary care also have some type of mental health issue, including depression. A recent study in Asheville, N.C., showed that 65 percent of primary care visits made by Medicaid patients involved a behavioral health issue.

Less-than-Adequate Access to Mental Health Care

However, many of those suffering from mental illnesses — especially those on Medicaid and the uninsured — have less than adequate access to the services they need. Providers tend to be located in cities, while more than half of the population of North Carolina lives in rural areas. Primary care providers are left to diagnose and treat behavioral health needs, despite a lack of training and familiarity with the issues.

This imbalance has been especially challenging in rural emergency departments, where a lack of appropriate mental health care resources often requires residents to wait several days before being seen by a qualified mental health specialist. With typical emergency room costs at $2,500 per day, crisis mental health situations can be frustrating and costly for both the patient and the hospital.

Response

To improve mental health services in the Carolinas, The Duke Endowment funded two major initiatives.

ICARE Partnership (North Carolina)

The ICARE Partnership is a statewide coalition that seeks to increase access to mental health care for North Carolina residents by promoting collaboration with primary health care providers. The partnership's name represents the type of health care system it seeks to develop: Integrated, Collaborative, Accessible, Respectful and Evidence-based (ICARE). This integration is considered necessary for the successful treatment of patients who struggle with mental illness, but are served primarily (or exclusively) by a family doctor, OB/GYN or other care provider.

From January 2007 to the end of 2008, pilot programs were funded in four North Carolina communities. With additional funding in 2007, the program began a three-year effort to extend the service statewide. Key steps included developing curriculum, holding training sessions for primary care providers, providing technical assistance to individual practices, and setting up a comprehensive web resource of mental health information. The partnership currently is being implemented in every community statewide.

Telepsychiatry (South Carolina)

The South Carolina Department of Mental Health and the South Carolina Hospital Association received funds from the Endowment to develop a telepsychiatry network. The network allows mental health providers to provide psychiatric consultations via telephone and video conferencing, giving patients in emergency departments greater access to mental health specialists.

The network will be staffed around the clock by a team of psychiatrists in order to evaluate and triage people seeking treatment for mental health issues in emergency departments.

In 2008, The Duke Endowment granted $3.9 million for the program, which supports a staff of four psychiatrists and telemedicine equipment for all of the 65 emergency departments in the state. The program enables patients, emergency department physicians and psychiatrists to interact through video screens, cameras and wireless communication. An additional unit is housed at the South Carolina Hospital Association, where it can be used for distance-training. Each cart includes:

26-inch, high-definition screen capable of capturing subtle symptoms crucial to accurate diagnosis
mounted camera which can pan, tilt and zoom at the physician's will
two-way sound for communication between the physician and patient
wireless capabilities and independent power supply
access to electronic medical records
connection to database (updated every 30 days) of patients with mental, behavioral, or substance abuse incidents