Two emerging areas of expertise are beginning to change the behavioral health delivery model: that of the emergency behavioral health clinician; and that of the behavioral health primary care physician. In some ways, the specialties have evolved from pure necessity.
Emergency Behavioral Health
In response to overcrowded prisons and budget cuts to state hospitals, mental health practitioners are increasingly contracted to work in crisis teams, intercepting individuals in emergency situations and assisting law enforcement in de-escalation and diversion efforts.
Sometimes the clinician’s focus is on keeping an individual alive another day to connect him or her to outpatient services tomorrow, says Jenny Stewart, crisis response services director for Heartland Family Services in Council Bluffs, Iowa. Her agency contracts with a county not-for-profit organization tasked with reducing acute hospitalization and incarceration.
In emergency behavioral health, teams of licensed practitioners help law enforcement de-escalate dangerous situations, create safety plans for individuals and provide immediate assessments for services. If inpatient service is required, for example, the emergency behavioral health clinician accompanies the officer and the offender to the hospital to facilitate a smoother transition and to expedite intake.
Stewart also is on the receiving end of a hotline for families seeking assistance in involuntary commitments for loved ones. Up until this year, the process involved police apprehending individuals and escorting them to a hospital for intake. Now, Stewart and others like her meet the individuals and attempt to persuade them into treatment.
She believes the contract work will last as long as the county continues to reap savings from the efforts.
“While the program may be costly on this end, it is saving the region money on the reverse.” She adds, “Just in the first two quarters for this year, 92 percent of the people that we visited onsite did not have to go on for further hospitalization or incarceration.”
Behavioral Health Primary Care
A new subspecialty in primary care that has emerged in the past few years enables family physicians to identify and address behavior in the context of chronic medical conditions, such as diabetes or heart disease. For example, a patient with diabetes might need to change exercise and eating behaviors.
Traditionally, physicians have limited their focus to the physical manifestations of disease and struggled to influence behavior, says Patrick Gauthier, director for the consulting firm AHP Healthcare Solutions. All of that is changing, however, at least in theory. Gauthier says that more than 100 medical schools across the country have begun to offer training in behavioral medicine that drives techniques such as motivational interviewing or cognitive behavioral therapy.
“In some respects, this is a really elegant solution for the primary care field,” Gauthier says. “But it is a threat to the behavioral health field.”
What’s more, quality is at risk as primary care dons yet another hat. It is uncertain how profitable the model ultimately will be for primary care physicians, but as their skills increase, payers might drive more patients their way, forgoing behavioral health professionals.
Adam Madison is a freelance writer based in Indiana.