One-stop shopping: GBMC doctors work to bring mental health services into primary care offices

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After she started practicing, Greater Baltimore Medical Center physician and director of primary care Dr. Robin Motter-Mast quickly realized that many of her patients weren’t receiving the psychiatric care they required. Many ignored referrals to specialists, she said.

“It doesn’t take you long to figure out that there’s a crisis as far as psychiatric care,” she said.

Motter-Mast is a part of the group teaming up across GBMC, Sheppard Pratt Health System, Kolmac Outpatient Recovery Centers and Mosaic Community Services to bring behavioral and mental health professionals into primary care doctors’ offices.

“Being an osteopathic physician means looking at people holistically,” she said, and sometimes the mental health piece gets left by the wayside, often because patients don’t follow through with referrals to mental health professionals due to costs or stigmas.

She’s joined in the effort by Dr. Catherine Harrison-Restelli GBMC’s psychiatry department chairwoman and a Sheppard Pratt psychiatrist, who said that doing so makes patients more likely to get the care they need and understand the importance of holistic care.

“You can have this sort of one-stop shopping where you recognize that sleep and mood and stress and substances all impact your physical health and vice versa,” she said of the program.

Harrison-Restelli said she was inspired to join the program by her work at a similar endeavor at the Department of Veterans Affairs.

“I saw that siloed medicine does not always serve patients well and they get better faster with a more integrative approach,” she said.

Of GBMC’s 10 primary care facilities, nine are now staffed with behavioral health and substance abuse consultants as well as part-time psychiatrists.

Success stories

The program began in January. Already, success stories abound. There’s a college student who was raped and saw her grades slipping before she got treatment for post-traumatic stress disorder through the program. There are numerous patients, too, who got treatment for mental health problems that were inhibiting the treatment of their chronic pain.

“If you can target depression in addition to pain you can get them off of opioids and make them more active and their quality of life is way better,” Harrison-Restelli said.

Doctors have been assessing patients using various screening tools and have noticed a 52 percent reduction in anxiety scores and a 36 percent reduction in depression scores. All told, 86 percent of behavioral health appointments have been completed, compared to just about 50 percent nationally.

There are numerous obstacles preventing many patients from making psychiatric appointments, the two doctors said.

Often, Motter-Mast said, there’s a gap between what psychiatrists charge and what insurance plans cover.

“When you have that recurring cost it really becomes a barrier to care,” Motter-Mast said. “These psychiatrists will see the patient and bill them under insurance. I know they take all the insurances that I take, so I don’t have to worry about that.”

Stigma can be a barrier, too, Harrison-Restelli said. Many patients feel embarrassed to seek help for mental health issues or simply don’t know that the symptoms they’re experiencing are tied to underlying mental health issues.

There’s also a shortage of care providers, she said.

A Mental Health Association of Maryland study released in January 2015 found that patients who bought private plans on a state exchange were supposed to have access to 1,154 psychiatrists. Researchers called each one, though, and only 14 percent of them had an appointment available in the following 45 days.

Patients with untreated mental health problems can overutilize medical services like emergency rooms, Harrison-Restelli said.

“It’s quite often that people come to the emergency room and they’re having a panic attack but they think it’s a heart attack and they end up with a million-dollar cardio workup,” she said.

For the patients who don’t receive the proper care, it can be a “giant domino effect,” she said.

“They smoke more and they drink more and they drive too fast and they have domestic violence issues and they don’t care for their diabetes or their high blood pressure,” she said. The list went on and on, ending in overutilization of nursing home facilities.

The program relies on grant funding, so its future is uncertain, but Motter-Mast said she anticipates incorporating technology and group care into the program.

“I envision telehealth and group classes down the road. I would also like to work with the specialist practices at GBMC to help them better meet the needs of their patients with these type of services,” she said.

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Promising Results

So far, assessments of 2,000 GBMC patients that began in January have found:

• 52% reduction in anxiety scores
• 36% reduction in depression scores
• 67% completion rate for substance abuse appointments
• 86% completion rate for behavioral health appointments

Source: GBMC

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