HBI Report Reveals Best Practices for Addressing Shortage of Mental Health Services
Every day, articles in the news highlight the need for greater access to mental health services. Rural areas in the United States are hit especially hard by a shortage of mental health professionals, but even residents of more populated areas face challenges in getting mental healthcare. Some experts are even calling it a “crisis.” Not surprisingly, healthcare leaders nationwide are looking for ways to reach patients in need.
HBI has seen a notable uptick in research requests related to mental health services. In response, the HBI Cost & Quality Academy recently published a new best practice report, A Contemporary Approach to Address the Current Mental Health Crisis. This report includes case studies and tools from some of the top-performing healthcare organizations in the country. For leaders interested in providing excellent mental healthcare to their communities, this report sheds light on tactics that have proven successful in a variety of contexts.
Integrating Mental Health Services Into Primary Care
Research shows patients increasingly seek care for mental health complaints in the primary care setting. One 2014 study in the Journal of Clinical Psychiatry found that between 1995–1998 and 2007–2010, the rate of primary care visits with mental health complaints increased by 42%, and primary care visits for mental health disorders increased by 51%. Given this increase, primary care staff are in a unique position to identify and rapidly initiate treatment for this patient population.
One organization featured in this HBI report, Intermountain Healthcare, which initially began mental health integration in its outpatient clinics in 2001. The initiative expanded throughout the years and now in place in all primary care clinics, as well as pediatric, geriatric, and internal medicine clinics. Brenda Reiss-Brennan, director of Intermountain’s mental health integration program, discussed the keys to success with HBI. The screening tools Intermountain uses and the mental health integration program’s care process model is included in this report.
Tackling the Mental Health Crisis in the ED
Based on data spanning from 2006 to 2013, AHRQ’s Healthcare Cost and Utilization Project estimate that about one in eight ED visits are related to mental health or substance abuse. If an organization does not have available psychiatric beds, patients may be boarded in the ED, leading to overcrowding, patient dissatisfaction, and underserved mental health needs.
HBI spoke to leaders about the efforts they were making to increase access to mental health services for ED patients. For example, Johns Hopkins Bayview Medical Center designated some ED beds specifically for psychiatric cases. Besides, the ED and psychiatry service lines partnered to establish a streamlined process for care, including handing off patients with psychiatric needs to a specialized consult service of psychiatrists, social workers, and psychiatric nurses.
When a patient presents to the ED in psychiatric distress, the consult service will be called so that a psychiatrist or psychiatric nurse can conduct appropriate assessments and gather a thorough history. To standardize the consultation in the ED, the organization created a form that prompts the questions staff should ask and any required examinations, like mental health status and mood. This form is included in HBI’s report, along with other tools to help providers with mental health initiatives in the ED.
Implementing Universal Suicide Risk Screening
Last year, suicide rates in the United States hit their highest point since World War II. To ensure that all patients at risk of suicide are identified—whether or not they are mental health patients—some organizations have implemented universal suicide risk screening. At times, this is contained in a specific unit or department, but some health systems are screening all patients at any point of entry.
In 2014, a focused survey by The Joint Commission found that a patient with a substance use disorder was not given a full suicide risk assessment during admission at Parkland Health & Hospital System. This prompted administrators and clinical leaders to initiate discussions on ways to improve the detection of at-risk individuals, which eventually led to the universal screening of patients aged 10 and up. As of 2019, suicide risk screening at Parkland Health & Hospital System had reached 98% compliance. HBI’s report includes details of this initiative that others can adapt to their organization.
HBI’s mental health report is available now for our members. To learn more about HBI membership, fill out the form below!