Expanded Psychiatric Care Can Transform Federally Qualified Health Centers

Federally Qualified Health Centers (FQHCs), which provide affordable comprehensive services in underserved communities, are a critical part of the American health care system. The expansion of psychiatric care in the FQHC system can make FQHCs even more transformative.

I have two distinct experiences as a psychiatrist at FQHCs in Louisiana. Since 2011, I have worked as a consultant to primary care teams in rural health care clinics (primarily FQHCs) across Louisiana. (Efforts to expand and integrate behavioral health services through a collaborative care system arose in part from the Deepwater Horizon Medical Benefits Class Action Settlement: Gulf Region Health Outreach Program.) This model helps to ensure the efficient use of resources and increase coordination, communication, and access to behavioral health care. I work both on site and via telepsychiatry and find both approaches to be effective.

In addition, for over a decade, I have run a weekly psychiatric clinic (fee-for-service, not based on a collaborative model) at an FQHC outside of New Orleans. In this setting, I regularly see a dozen or more patients a day and manage the tension between obligations to current patients and the community’s need for new referrals—a tension common throughout the country, where many have limited access to psychiatric services. In Louisiana, FQHCs are one of the few settings that receive adequate reimbursement for Medicaid patients; thus, FQHCs are one of the only settings where most children in Louisiana can access psychiatric services.

Through my work in various FQHCs and different care delivery systems, I can see that growing both standard clinics and adopting team-based collaborative care at FQHCs will take pressure off schools, social service agencies, law enforcement, and courts. These agencies frequently interact with individuals who do not have access, but could benefit from community-based outpatient behavioral health care.

Community mental health centers, substance abuse treatment programs, emergency rooms, and inpatient psychiatric units struggle to fulfill their specialized missions, as the current system of care is siloed and fragmented. A comprehensive medical home for patients at FQHCs would enable most behavioral health care to be delivered in a primary care setting and, as needed, patients can be matched with the correct type of specialized care, including higher levels of service for the acutely ill.

In addition to increasing the availability of behavioral health services, more must be done to change how behavioral health care is approached. Rather than prescribing costly medications with limited clinical benefit, more must be done to emphasize the value of psychotherapy and mind-body techniques such as breathing exercises, mindfulness meditation, and expressive therapies. Self-help is also underutilized: quality psychoeducation and self-help are inexpensive, easy to access, and surprisingly effective.

Poor nutrition, a sedentary lifestyle, and sensory overload are the enemies of both physical and mental health, and FQHCs are a perfect setting for offering comprehensive interventions aimed at both physical and mental health care. FQHCs also offer the opportunity to expand supports for entire families, including increasing parent training and family therapies.

To be truly transformative, FQHCs will require additional social workers, care managers, and/or embedded behavioral health specialists. Psychiatrists must be supported in their various roles, including both as treatment providers and as collaborators supporting primary care teams. ■