Khadijia Tribié Reid, MD, MPH Pediatrician and public health advocate
Published 6:30 am ET Mar 12,2021
Last month, Carolina’s Cape Fear region received big news. Basketball icon Michael Jordan donated $10 million to Novant Health to build two primary care clinics in New Hanover County. He delegated these dollars to create clinics that will provide primary and mental healthcare in the same space. This model is called integrated primary–behavioral care. As a physician, I can testify that expanding integrated care is just what the doctor ordered.
Under an integrated care model, medical providers, counselors, psychiatrists, and social workers collaborate to get patients what they need to be healthy. This model recognizes the link between medical and physical health. As a professional, integrated care has revolutionized the way I practice medicine. Here are just a few ways providers can use primary-behavioral health integration.
1) Post-partum depression. At some point during every infant exam, I look at the baby’s mom and say, “And how are you doing, mom? Are you sad?” I cannot count the number of times the answer has been, “Yes.” The American Academy of Pediatrics recommends that doctors screen moms for post-partum depression in the first two years of baby’s life. Yet, many primary care providers are not equipped to manage the 3 million women in America who experience postpartum depression annually. Although medication can be helpful, therapy is also a great treatment option. Ideally, integrated care provides a space where a mom can meet with a counselor that same day.
2) Adverse childhood experiences (ACEs). Adverse childhood experiences cause poor adult health. ACEs include homelessness, food insecurity, abuse, neglect, community violence, having chronically ill caretakers, and having substance abusing caretakers. The more of these experiences a child endures, the higher that child’s likelihood of experiencing heart disease, cancer, obesity, drug addiction, suicide attempts and other chronic illnesses in adulthood. Integrated care provides a space where this correlation is in full view. Social workers can address some of these adversities in a practice where medical providers understand the ACEs link to health. Consider how this impacts not only the child’s future, but how it acknowledges the caretaker’s past. For example, if a child presents in my office with “hyperactivity,” the child is connected with a therapist to evaluate their social and educational history before considering medication. Likewise, the parental social history is considered in the treatment of that child and family.
3) Eliminating barriers. The term “poor compliance” is commonly used in medicine. From a medical provider’s perspective, it means, “The patient just won’t do what I ask.” This bad behavior on the part of the patient is one of the most frustrating aspects of practicing medicine. All too commonly, patients don’t follow through on our most important advice – “exercise more,” “eat more vegetables,” and “take your medicine.” At every return visit, medical providers feel like we are having the same conversation with so many of our patients. Integrated care provides a space where a medical provider must consider all the reasons our patients don’t follow through. For example, we ask families to exercise but is there a safe space to exercise in their community? Likewise, how far must that patient travel from home to get fresh vegetables? Are the costs or side effects of medications a barrier? In traditional practices, medical providers rarely have the bandwidth to consider these external factors. Yet, these are the very factors that will ultimately impact patient health.
Integrated primary-behavioral care addresses the whole person. The coronavirus pandemic has shown us just how intertwined health, social welfare, and mental wellness are. Americans are experiencing increased rates of depression and anxiety. We also have witnessed the impact of job loss on our mental and physical health as people struggle to keep food on the table. While these are indeed extreme times, the link between medical and mental health is not unique to this pandemic. Merging medical and mental health care is s step towards better health for us all.