CDC director highlights mental health focus at Family Health Centers of San Diego

In the world of health care reform, the word upstream means investing in early intervention, treating small problems in the clinic before they become large enough to require hospital stays.

Family Health Centers of San Diego, the region’s largest network of community clinics, has done so well in that regard with mental health care that the nations top public health official left Tuesday to a look around.

Dr. Mandy Cohen, director of the US Centers for Disease Control and Prevention, visited the City Heights Family Health Center on El Cajon Boulevard, drawing on a careful combination of resources from family medicine and care prenatal to physical therapy and chiropractic.

Mental health care, explained Dr. Christopher Gordon, president of Family Health Centers, is integrated into the daily process of care at the more than 90 sites the organization operates.

At intake, no matter why they came in, each patient answers two quick questions, whether they’ve been bothered by having little interest or pleasure in doing things, and whether they’ve felt down or depressed. Those who answer yes are asked to answer nine additional questions and, depending on the results, can end up with an immediate mental health care visit, often without leaving the building.

With everything integrated, we can call a therapist and say, well, this person might need some attention, and we can have a warm handoff right away, Gordon said.

Family Health Centers’ focus on providing comprehensive services to their patients was part of the reason a visit was included in the CDC directors’ national tour to promote mental health services and suicide prevention. Another draw, he added, is the eight-story building going up just east of the clinic. The mixed-use, mid-rise structure will house a 20,000-square-foot mental health clinic with upper floors made from repurposed steel shipping containers, creating 41 new housing units, 18 of which are set aside for San Diegans without accommodation

The most notable thing about this new building is that they include housing, Cohen said. If you don’t have stability in your housing, stability in your food security, it’s hard to get well, and that’s why I love that they’re including housing as part of their new building.

The idea of ​​integrating mental health care into primary care is one that has been growing for decades since University of Washington psychiatrist Jrgen Untzer created a collaborative care model that calls for the integration of mental health care into first-line primary care practice.

Most recently, Rady Childrens Hospital began using this model in some of its primary care clinics with significant positive results. The researchers found that primary care physicians screening young patients for signs of depression was correlated with a 44% reduction in anxiety symptoms and a 66% reduction in depression symptoms. And an internal analysis of patient referral patterns also found that those who were seen in doctors’ offices presented less often to specialized psychiatric emergency departments at San Diego Children’s Hospitals.

Domonique Hensler, senior director of systemwide care at Rady, said in an interview in early April that the current challenge with the expansion of integrated psychiatric care in pediatric physicians’ offices has not been training the family medicine doctors to run tests for signs of depression or get social workers to do immediate consultations, but rather get health insurance companies to reimburse for the work.

Some are starting to eliminate their pre-authorization requirements or already have, and that’s a game changer, but others still have a foot in both worlds, Hensler said. Some of the health plans subcontract to an outside provider, doing mental health issues with another agency.

Medi-Cal, the health insurance of last resort for California’s neediest residents, also has several programs that can support the integration of mental health care into doctors’ offices, although the programs existing ones don’t quite fit the system that has been created in their pediatric clinics, Rady analysts said. .

Luke Bergmann, director of behavioral health for San Diego County, said in a recent interview that federally qualified health centers, such as family health centers, have improved the ability to get these services covered by Medi- Cal, a fact that Gordon confirmed.

What will it take to get this mode of care fully embedded throughout American health care?

Talking to experts from different parts of the country, he said, is part of the process. Understanding how medical providers successfully integrate mental health into routine office visits can help change the system, Cohen said.

Then I can go to my partners at Medi-Cal or Medicare and say, look, this is the best evidence, Cohen said.