OhioHealth project links primary-care offices, mental-health treatment
July 5, 2018 | By JoAnne Viviano
Veronica Barnett’s eyes light up when she talks about her grandsons’ excitement in Franklin Park after fishing for the first time.
It was Father’s Day, and she and her husband and the boys, ages 2 and 4, were enjoying a sunny day and the beauty of nature.
For Barnett, the experience at the Near East Side park is one she wouldn’t have dreamed of a year earlier. Mired in depression and dealing with overwhelming anxiety at the time, she rarely left her bedroom.
But last fall, she became one of the first clients to take advantage of a new OhioHealth program that offers people suffering with depression access to mental-health specialists right in the offices of their primary-care doctors.
Through the program, which started in November, all patients are screened for depression via a nine-item questionnaire at least once a year. If a doctor determines that depression is present, the patient is offered an immediate appointment with a specialist.
A goal is to place specialists in 29 sites, representing just under half of OhioHealth’s practices, over three years. About 600 patients have taken advantage of the new service, said Dr. Dallas Erdmann, OhioHealth’s medical chief for behavioral health.
The initiative came just months before a federal report showed that the U.S. suicide rate rose by 25 percent between 1999 and 2016, including a 36 percent increase in Ohio. Research also shows, Erdmann said, that about two-thirds of suicide victims visit a health-care provider in the month before their death.
“The question to them becomes, ‘Could we have done anything to have identified that and impacted that patient to have prevented that loss?’” Erdmann said. “What the behavioral-health integration model does for those clinics that are involved is that all of the patients are screened for depression.”
When depression is indicated, a doctor will prescribe medication if necessary and offer access to a behavioral-health specialist in the same visit. Psychiatrists assigned to the practices consult with the specialists weekly and are available by phone for physicians.
Erdmann said recent research shows that such models improve access to and quality of care and reduce treatment costs. Addressing depression, he said, enables patients to better address other health issues, such as diabetes or cardiovascular disease.
Barnett, 52, said she had suffered for years, and the day she entered the program was the best of her life.
Although the bedroom in her East Side home is still her “safe place,” she’s socializing again and is back at church. She takes walks in her neighborhood and waves to her 12-year-old granddaughter during recess at the nearby Africentric Early College school.
She visits parks, a favorite being Topiary Park behind the Columbus Metropolitan Library Downtown, where she once sat back and realized, “Wow, I was missing a lot.”
“It’s helped me to have me again,” she said. “I’m back to Veronica.”
Barnett first met Lyndsey Nadolson, a registered nurse who specializes in behavioral-health care, at the OhioHealth Primary Care Physicians office Downtown, the site of one of the initiative’s pilots.
Through the program, Nadolson and Dr. Amanda Maynard have assisted more than 160 patients at the office.
“It has actually been tremendously successful,” Nadolson said. “Before this program came along, people just kind of dealt with things because it’s too hard to get into behavioral health anymore. There are not enough psychiatrists, there’s not enough places to go anymore, and if you do find someplace to go, it’s a six- to eight-month waiting list just to get in the door.
“With this, people are coming into the office, and things are immediately getting addressed. Patients are like, ‘Oh, my gosh, this is a whole other ballpark,’” she said. “These mental-health issues are getting tackled in the office instead of just letting them go.”
Currently, services are being provided at no cost to patients as part of a $15 million commitment by OhioHealth to expand behavioral-health programming. Although Medicare has authorized coverage for such collaborative services, Erdmann said efforts are underway to get Medicaid on board, with hopes that private insurance companies will follow suit. He expects that patients would have to cover a monthly co-payment for the behavioral care.
Maynard said the screening took about 10 extra minutes per visit when she started but has become second nature to patients.
“When you don’t ask the right questions, you don’t know exactly what’s going on, and I was amazed to see that just a simple questionnaire handed to a patient could trigger this many results,” she said. “Some of the people I had been taking care of for years, I didn’t know they had an issue until we asked the question.”
Erdmann said another benefit of the program will be its use of virtual health care so that patients in need at offices that don’t have a behavioral-health provider on-site can immediately access one via a video system similar to Skype or FaceTime.
Nadolson said that many of her patients have improved, similar to how Barnett has, and about half had thought that depression was “just a way of life.”
“There is no more of that anymore,” she said. “People can actually start living their lives and being happy because of this program.”
Maynard said she’d like to see the model become a standard of care across the health-care industry, and Nadolson hopes that OhioHealth can serve as a catalyst.
“The issue and the problem, it’s real, and it’s everywhere,” she said. “So I hope other health facilities see OhioHealth and say, ‘Wow, that’s a big deal. They’ve made a big difference. … We should try to mimic that.’”