Integrated Care: Perspectives From A Behavioral Health Consultant
Jennifer Noonan, L.C.S.W., is an employee of Regional Mental Health in Merrillville, Ind. She is contracted to provide behavioral health services at Northshore Health Clinics at its Lake Station office. Jürgen Unützer, M.D., M.P.H., is a professor and chair of psychiatry and behavioral sciences at the University of Washington and founder of the AIMS Center, dedicated to “advancing integrated mental health solutions.”
Integrated care requires a team of professionals with complementary skills who work together to care for a population of patients with common mental health problems. It involves a shift in how medicine is practiced, the creation of new workflows, and the addition of new team members beyond the primary care provider and the patient. In this issue, we hear from Jennifer Noonan, L.C.S.W., a behavioral health consultant who works alongside psychiatrists on an integrated care team. —Jürgen Unützer, M.D., M.P.H.
I have worked at a local community mental health center for the past 23 years in a variety of positions—inpatient case manager, crisis intervention specialist, group home supervisor, day treatment/clubhouse supervisor, outpatient therapist, and, for the past 10 years, a behavioral health consultant on an integrated care team. Of all of the roles I’ve had, working on an integrated care team has been the most effective in bringing about change and improving patients’ lives. I cannot imagine going back to providing traditional services. I don’t think my experiences are unique, and I offer the following reasons why providing mental health services on an integrated care team is truly rewarding.
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Timely access to care: The ability to provide services in an integrated setting speeds up the process significantly for both the mental health and physical health sides. If there are untreated/uncontrolled medical issues or immediate referrals for specialty care (neurology, endocrinology, and so on) or labs/diagnostic studies, those can be coordinated the same day and vice versa—if the primary care providers have someone in crisis, I can meet with them and get services started or coordinate more intensive services if need be (inpatient psych or substance use treatment).
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Less paperwork: The amount of paperwork is much less than I had previously, which allows me to provide services more quickly. I am not bogged down by notes, treatment plans, and so on. I also do concurrent documentation so I am mostly finished with paperwork by the end of the day. This also means I have time to have lunch instead of catching up on paperwork.
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Effective therapy: We continue to offer therapy in the primary care setting, including behavioral activation therapy, cognitive-behavioral therapy, and motivational interviewing techniques, but we are not tied down to the “hour.” I have seen more of my patients move forward in an integrated care setting than I had when I worked in a regular outpatient setting. I believe that the old way of doing therapy created a dependency and kept people in a “patient” role longer. There are times a patient has to be referred out—usually patients who are not responding to medications, have extensive trauma histories, or have ongoing addiction issues—but we can help the vast majority of patients at the clinic.
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Increased knowledge: The knowledge base I have gained from working directly with psychiatrists and other medical professionals has increased my ability to be a better and more effective practitioner. This is particularly true when working with patients who have bipolar disorder or other mood disorders. The psychiatrists teach me to watch for possible medical situations that might be impacting or interfering with a patient’s mental health. When we can attack mental and physical health conditions at the same time in a coordinated way, we get faster results.
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Less stress: My stress level is almost nonexistent, and I have a distinct separation between work and home. My sleep has been the best it has ever been since becoming a behavioral health consultant. I don’t dread getting up when the alarm goes off.
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More variety: There is a lot of variety that keeps me on my toes. I have been exposed to more interesting situations and histories in the integrated care setting than ever have before, which continues to challenge and expand my knowledge base. Many of the patients in a primary care setting have never talked to anyone in the mental health field.
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Compassionate care: My ability to handle grief with patients has also improved. I am called in to appointments in which people receive devastating medical diagnoses, women who experienced stillbirths and miscarriages, and so on. I am able to forge a partnership immediately rather than having to tell them to go to a mental health center and start services with another agency.
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Happy doctors: The majority of the doctors with whom I work welcome the fact that my colleagues and I are there to help address their patients’ mental health issues. We’ve built up an incredible amount of trust within the integrated care team. Everyone relies on and trusts each other’s knowledge and expertise.
Of course, not every job is perfect, and I do face some challenges, particularly in the area of service coordination. But the rewards more than make up for the setbacks. Working on an integrated care team has been the most rewarding job I’ve ever had, and it’s given me an enormous amount of personal and career satisfaction. ■
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Psychiatrics News
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Published online: 14 August 2018
Published in print: August 4, 2018 – August 17, 2018
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