That’s the number of U.S. adults who experienced a mental illness in 2018, according to the National Alliance on Mental Illness. While depression and anxiety disorders are among the most common conditions experienced, schizophrenia, bipolar mood disorder, personality disorders, trauma and eating disorders can also interfere with daily activities and productivity if left unchecked.
In fact, even though one in every five adults experienced a mental illness in 2018, only 43 percent of those ever received treatment. With depression being the leading cause of disability worldwide, it is particularly troubling when treatment is not sought. Many mental illnesses can manifest into serious health problems when left untreated.
According to the National Alliance on Mental Illness, people with depression, for example, have a 40 percent higher risk of developing cardiovascular and metabolic diseases than the general population.
As the link between mental health and physical health comes increasingly into focus, health systems like Memorial Hermann are working to meet patients’ needs by helping diagnose and treat behavioral health conditions before they become expensive and debilitating complications.
People like Sierra*, a 29-year-old woman, who left work one day knowing something was wrong. It was hard for her to put into words exactly what she was feeling, but she knew that she needed immediate medical attention.
Luckily, she was able to get a same-day appointment with her primary care physician. As her physician asked a series of questions, Sierra became concerned; she didn’t have any physical ailments or aches, but she didn’t feel like her normal self. For more than a month she had felt an overwhelming sense of hopelessness. When she wasn’t at work she found herself curled up in bed sleeping, even on the weekends. She declined offers to social activities with friends and family, and even stopped participating in her favorite pastimes. It had become common for her to go an entire day and forget to eat; she didn’t have an appetite.
As she sat across from her physician, Sierra realized his questions had stopped. She and her doctor locked eyes. He had a look of deep concern on his face, one Sierra had never seen before.
“Let me get someone in here to speak with you about the next steps,” he said. He left the room and a short time later a woman entered. Sierra silently read the woman’s employee badge, Licensed Clinical Social Worker.
“Hello Ms. Sierra, I’m Blaine, a clinical social worker here. I’ve read your doctor’s notes. Can you tell me a little bit about what brings you in today?”
While Sierra’s story is just one among countless others, it’s an example of how health systems are striving to provide early interventions to curtail bigger problems later on. For Memorial Hermann, the intervention now starts at the first place where patients interact with a medical provider: The office of their primary care physicians.
Memorial Hermann has embedded behavioral health specialists in several Memorial Hermann Medical Group clinics, as well as in the Memorial Hermann Neighborhood Health Center – Greater Heights. Every patient undergoes screening for mental health issues during his or her visit, and those identified as needing more intervention are immediately connected with a specialist who is trained to help.
“Our primary care physicians and specialists are able to utilize evidence-based screening tools to identify early signs and symptoms of emotional distress and mental illness and initiate treatment that provides for the integration of physical and mental health care in one setting,” says Theresa Fawvor, Memorial Hermann’s Vice President, Behavioral Health Services. “If a patient presents with signs and symptoms of a mental health illness, there is an immediate handoff between the patient’s physician and the licensed clinical social worker at the clinic. If the social worker is with another patient at the time, a referral is provided and the social worker follows up with the patient.”
The approach aims to help destigmatize mental illness and reach those who previously went untreated.
Fawvor says screening patients for behavioral health issues is best practice for healthcare providers and promotes overall wellness. It’s a care delivery model that makes sense, she says, since providers, especially primary care physicians, often have established relationships with their patients, and have fostered a level of trust that allows them to open up in ways they may not feel comfortable doing otherwise.
The concept of embedding behavioral health workers into the primary care space has been years in the making at Memorial Hermann, and was finally made possible in part by a federal program that is designed to increase access to health care, improve the quality of care, and enhance the health of patients and their families.
Memorial Hermann first started integrating behavioral health services with a pilot project in 2017 and has since expanded the model, which has proven to be successful. Among those who have been seen by behavioral health specialists within the primary care space, Memorial Hermann has documented a noticeable decrease in depression and anxiety symptoms in patients treated via integrated care.
Being able to provide mental health clinicians on-demand in many instances at Memorial Hermann Medical Group clinics is also helping to quell occurrences of patients experiencing unchecked mental health emergencies that escalate into emergency room visits. That’s especially important right now, as suicide rates across the country reach their highest levels since World War II. According to the Centers for Disease Control and Prevention, researchers have documented a 33 percent rise in instances of suicide in the past two decades – driven higher by multiple factors, including the nation’s opioid crisis, heightened stress levels and an increase in cyberbullying via social media. With mental health crises reaching a crescendo, it’s critically important to reach people as early as possible.
“By embedding licensed clinical social workers in our clinics, we are helping patients get healthy and lower the cost of their care by allowing them to avoid costly ER visits,” Fawvor says. “Our goal is to make sure patients have the necessary resources available to ensure their overall wellness – mind and body.”
For people like Sierra, the results can be transformative. She’s now back to work, finding joy in life’s simple pleasures and feeling like her old self again.
*Name and details have been changed to protect confidentiality.