Intermountain Healthcare Bryner Clinic incorporated mental health screening into primary care practice a decade ago as a test project.

Now mental health is becoming part of Intermountain primary care physicians' practices. And health organizations nationwide are watching and in many cases emulating the change.

On Friday, LDS Hospital was the venue for a daylong "Mental Health Integration Retreat," which included some training sessions on how to incorporate mental health screening into patient care. Dr. Linda Leckman, vice president over Intermountain's Medical Group, said the practice treats the whole patient for better overall outcomes and increases satisfaction of both provider and patient.

Often, doctors must tease out whether the cause of a medical complaint has some basis in mental health issues, such as anxiety or depression. "About 60 percent of problems have a behavioral health component," Leckman said.

A diabetic who is having trouble managing his care regimen may have mental health issues that complicate things. Or a headache may have its roots in anxiety. There are endless variations.

That's why the participating practitioners screen all of their patients for depression, for instance.

Mental health integration is cost-neutral, Leckman said; total medical expenses actually go down somewhat. And making mental health a routine part of care removes the stigma that has, unfortunately, been attached to it, she said.

The mental health integration movement started with Brenda Reiss-Brennan, an advanced practice nurse with considerable mental health expertise, who was practicing at a non-Intermountain facility and teamed with a family practice there to fold mental and physical health together on a small scale. When she moved to Intermountain a decade ago, the pilot at Bryner was launched to see how it would work and what it would offer.

Pediatrician Dr. George H. Durham III said the difference is clear.

Some children have anxiety or depression or act out at school. Some have problems that can lead them to juvenile court. Integrating mental health care into the clinic setting helps the doctor who doesn't specialize in mental health appropriately deal with the issue or know when to refer someone.

Because Intermountain has mental health experts working in a team approach at its clinics at least part time, care and consultation are readily available. That's especially important, because people in crisis or who need help don't always follow through when it's not convenient or requires effort to go somewhere unfamiliar.

It begins with a couple of simple screening questions. Besides health questions, patients are asked if they've been depressed in the last two weeks, for instance. The primary care providers are trained in what to look for and what to do next in this team approach to whole-body care, Reiss-Brennan said.

Heather Craghead told her experience as a patient who has suffered. When she was pregnant, she fell into a mind-numbing depression. It was a general practice doctor who helped her get the mental health support she needed, and it is to him she turns when things don't feel quite right. He helps her, working with the team integrated within his clinic, she said.

"If you don't have a mental health care manager, I would say get one for your patients," she told those at the retreat. "It really works."

The integration is a fairly new thing. Durham likens it to where medicine was in terms of dealing with infectious diseases 100 years ago — somewhere between discovery of infection and the development of antibiotics. "I think the 21st century is where we will come to know a lot more," he predicts.


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