Care, Centered

When health care focuses on the whole patient, it’s possible to treat depression and anxiety alongside physical ailments like pelvic pain and arthritis. See how it’s happening at UT Health Austin.

Sharon had long looked forward to her 50s. By 52, her children were grown. She was ready to become more socially involved — maybe, even, to date again.

But recently, Sharon — who’s not a real patient, but an example of women’s experiences that are all too common — had started having chronic pelvic pain and urinary incontinence, relatively common ailments for some middle-aged women. Most nights, her health challenges and depression were causing Sharon to stay home. She’d begun to worry about her drinking. She’d gained a bit of weight, too.

Typically, when someone like Sharon seeks medical treatment, her doctor will do her best to provide a solution for the physical ailments. If Sharon is lucky, she might also be referred to a mental health care provider for help with her depression and substance use. But Sharon may not follow up. The appointment with a psychiatrist may take months to schedule. Or her insurance may not approve psychological care at all.

UT Health Austin, the clinical practice of the Dell Medical School at The University of Texas at Austin, is working on the problem as part of its team-based, patient-centered approach to — as the school’s mission states — “revolutionize how people get and stay healthy.”

UT Health Austin specialty clinics follow the integrated practice unit model created by Elizabeth Teisberg, Ph.D., executive director of Dell Med’s Value Institute for Health and Care, and Michael Porter, Ph.D., a professor at Harvard Business School and director of its Institute for Strategy and Competitiveness, in their 2006 book “Redefining Health Care: Creating Value-Based Competition on Results.” The clinics bring together groups of specialists who work together to treat each patient’s specific needs. Led by nurses and doctors, teams may include a dietitian. A physical therapist. A dermatologist.

Even a social worker, coordinating mental and behavioral health care. The Department of Psychiatry at Dell Med is collaborating with Integral Care, Travis County’s local mental health and intellectual and developmental disability authority, on this integration — which ensures that patients like Sharon receive holistic treatment.

The Collaborative Care Model

“This concept is adapted from the University of Washington’s Collaborative Care model, which was developed for primary care clinics,” says Garrett Key, M.D., director of mental health integration in Dell Med’s Department of Psychiatry. “We’re taking the model to specialty care clinics in an effort to address primary care-level mental health problems — things like depression, anxiety and substance abuse — and improve overall outcomes.”

At UT Health Austin, care managers from Integral Care — social workers — are proactively involved in patient care. “Social workers are able to help address the needs of patients that are otherwise a barrier to better health and better living,” explains Integral Care’s Becky Morales, LCSW, manager of Collaborative Care at Dell Med. “Often operating outside the normal care pathway and used in limited scope, we’re typically brought in to triage patients in crisis or connect patients to resources if they lack basic things like housing or food. But in our adaptation of the Collaborative Care model, we are engaged as part of the care plan, with a much broader scope.”

Social workers are trained to comprehensively address patients’ mental health needs, says Morales. In the Collaborative Care model, they provide brief psychotherapy, case management and follow-up care, in addition to consulting with psychiatrists about treatment plans and medication recommendations. This relationship helps maximize the impact of scarce resources — important because of the shortage of psychiatrists not only in Austin, but also across the country.

“The average wait to see a psychiatrist can be three to six months. It’s often even longer for child or adolescent psychiatry,” says Morales. “But the most common mental health needs don’t require specialist care — we can provide quality care for most people without making a formal referral. And when circumstances are more complex, we can connect patients to more comprehensive mental health resources.”

Mission Alignment

“By combining the skills, expertise and knowledge of Dell Medical School and Integral Care, we’re creating an opportunity to have a significant impact on the mental and physical health outcomes of patients in Travis County,” says David Evans, CEO of Integral Care.

“To treat one condition without recognition and treatment of another condition can result in patients needing more care without experiencing improved health outcomes,” he says. “Integral Care’s experience providing mental and primary health care and chronic disease management services for people living with mental illness and substance use disorder have shown us that when you treat the whole person, their health and well-being improve.”