On Oct. 11, the AAMC hosted a virtual congressional briefing, “Confronting the Mental Health Crisis: The Value of a Team-Based Approach.” The briefing was sponsored by the Congressional Academic Medicine Caucus, co-chaired by Reps. Kathy Castor (D-Fla.) and David McKinley (R-W.Va.). The briefing outlined the value of “integrated behavioral health,” a model of care in which primary and specialty care providers work directly with behavioral health clinicians to address the medical, behavioral, and social determinants of health and well-being.
Over 100 congressional staff and other attendees participated in the briefing, which was moderated by Leonard Marquez, AAMC senior director of Government Relations and Legislative Advocacy.
Marquez discussed the AAMC’s legislative recommendations to expand the behavioral health workforce, promote the integration of physical and behavioral health care, and ensure access to care. He highlighted the AAMC’s behavioral health advocacy agenda, which outlines the association’s priorities in this space, and presented a new research brief from the Research and Action Institute exploring barriers to mental health care access.
The briefing featured behavioral health experts from AAMC member institutions, including:
- Amit Shahane, PhD, associate professor of psychiatry and neurobehavioral sciences at the University of Virginia School of Medicine.
- Rachel Weir, MD, chief of Mental Health Integration for the Huntsman Mental Health Institute and the University of Utah Health.
- Lisa Ramirez, PhD, associate director of Pediatric Psychology for the MetroHealth System School Health Program.
- Anna Ratzliff, MD, PhD, director of the University of Washington Psychiatry Residency Training Program and co-director of the University of Washington AIMS Center.
Shahane provided attendees with an overview of integrated behavioral health (IBH), detailing how these models differ from traditional models of behavioral health care. In a traditional model, he explained, if a medical provider identifies a behavioral health condition during a visit, they can provide a referral to a specialty mental health clinic, but the onus is on the individual patient to fulfill the referral. Due to workforce shortages and network adequacy challenges, it is often difficult for patients to identify a behavioral health provider who accepts their insurance. Shahane explained how IBH models can help address this challenge and connect patients to care by embedding behavioral health providers in primary care and specialty care settings. He concluded by summarizing the robust body of evidence demonstrating the efficacy of IBH models at expanding access to care and reducing wait times, improving mental health outcomes, and promoting patient and provider satisfaction.
Weir’s presentation explored how her team leverages technology to identify mental health conditions and connect patients to care. She described how innovations in the electronic health record can help providers proactively screen for, identify, and treat behavioral health conditions. She also shared how her system uses technology-enabled interprofessional consults (eConsults) to improve the speed and efficiency of communication between medical providers and psychiatrists. Weir noted that eConsults allow the consulting psychiatrist to extend their expertise to many more patients than under the usual model of care, “As a psychiatrist, I can complete four eConsults in the same amount of time that it takes to evaluate and treat just one person, and I can also use eConsults to triage people and get them to the appropriate level of care.” This work is supported by the AAMC’s Project CORE: Coordinating Optimal Referral Experiences.
Ramirez discussed the implementation of IBH training and patient care models in the pediatric setting. She noted that the implementation of IBH at the MetroHealth System has helped to dramatically reduce avoidable mental health-related emergency department visits for children, resulting in significant cost saving. She also described how the Health Resources and Services Administration Title VII programs, such as Behavioral Health Workforce Education and Training and Graduate Psychology Education help to support this work. She emphasized the need to support these programs, noting, “Integrated behavioral health is not necessarily inherent in graduate medical education yet ... this is a way of increasing that pipeline, of showing what that teamwork looks like.”
The briefing concluded with a presentation from Ratzliff, who discussed the importance of exposure to IBH models during residency and training. She emphasized that, in light of behavioral health provider workforce shortages, it is important to orient trainees to a population-based approach to mental health care delivery. She discussed some of the skills trainees must cultivate in order to succeed in an IBH model and delivery a full range of evidence-based treatments in primary care settings, including brief interventions like motivational interviewing and problem-solving treatment.