Accessing mental health care is challenging for many Americans. And as COVID-19 has exposed inequities in the nation’s health system, mental health care is among the fault lines that the pandemic has laid bare.
The AMA established the Behavioral Health Integration (BHI) Collaborative with seven other leading physician organizations to help overcome persistent obstacles to integrating behavioral and mental health care into primary care practices and expand access to vital treatments for more patients. The goal is for the patient to receive mental health care within the primary care office, whether from a psychiatrist, other mental health professionals or a combination, using a team-based approach.
During a recent BHI Collaborative webinar hosted by the AMA, three physician experts discussed how mental health professionals and primary care physicians can work together to provide coordinated, culturally informed and equitable care for patients no matter their race, ethnicity, socioeconomic status, sexual orientation or gender identity.
“We must certainly make sure that people see help seeking for mental health in the same manner they would see help seeking for a broken arm or other chronic medical condition,” said Patrice A. Harris, MD, MA, immediate past president of the AMA and an Atlanta psychiatrist. “But we again must acknowledge that there are systemic inequities that prevent marginalized and minoritized from seeking help in this area.”
During the hour-long webinar—“Advancing health equity through BHI”—three physicians on the front lines offered a number of ideas on how to support patients who need mental health care and what physicians can do now to help make equity part of their practices.
A lot of patients provide information about the culture in their neighborhoods, communities, schools, workplaces and homes. All of those things have importance, said Melvin Oatis, MD, a psychiatrist in Manhattan and clinical assistant professor of child and adolescent psychiatry in the New York University Grossman School of Medicine.
“We’re thinking people are having the same experiences we are having,” Dr. Oatis said. “Oftentimes, you really don’t understand or don’t know unless you ask the question specifically.”
"Try to gain the full picture of what a patient is going through," said Nathalie Moise, MD, MS, an internist and director of implementation science research at the Center for Behavior Cardiovascular Health at Columbia University Irving Medical Center. For example, can the patient afford a medication?
Dr. Moise said she is a big proponent of conducting quality improvement analyses. She said you can look at the data at the clinic level to see if there are any differences in outcomes between patients and make changes based on the findings.
Bring together members of the integrated team and brainstorm the most innovative things you can do tomorrow to address equity.
If all of your patients only have mild symptoms, or are very high functioning, or they have gone to therapy every week for years, ask to what extent you can create room for patients who are not doing as well, Dr. Moise said. For example, can you bring in patients who are having more acute problems?
"Ask patients of color if they feel comfortable and welcome in your office and ask what you can do if they do not feel welcome," Dr. Harris said. Look at the magazines in waiting rooms and look at the artwork or informational posters on the wall. Are they representative of a diverse set of patients?
To help physicians offer mental and behavioral health services their practices, the BHI Collaborative has created the Overcoming Obstacles webinar series.
The Behavioral Health Integration (BHI) Compendium, a one-stop online collection of resources from eight national physician organizations designed to help you on your integrated health care journey no matter where you are on the path, also is available.