One in five Americans experiences a mental health issue at some point during their lives, and seven percent of adults live with serious mental illnesses. Depression alone is the leading cause of disability worldwide, and both depression and anxiety cost the global economy over $1 trillion dollars annually. To say that mental health issues are prevalent would be an understatement. It’s estimated that one out of every eight emergency room visits occur due to mental illness.
Unfortunately, many people in need won’t get treated due to healthcare staff shortages and disjointed healthcare frameworks. According to the World Health Organization, 66 percent of people with mental disorders go untreated and alarmingly, a National Institute of Mental Health study shows that 40 percent of adults with schizophrenia and 51 percent of adults with bipolar disorder go untreated.
For healthcare providers, mental illnesses present a major challenge. Primary care physicians (PCPs) and emergency room doctors often don’t have the tools and resources to appropriately treat these patients. This leads to patients being bounced around the healthcare system in an effort to find a suitable mental health professional to diagnose and treat them. Unfortunately, due to the vast shortage of psychiatrists, psychologists and therapists in the United States, some people will never find the help they desperately need.
Understanding the Challenge of Traditional Mental Healthcare Systems
In the traditional mental health model, PCPs have two options when patients approach them with mental health issues:
- They can attempt to treat the patient themselves (typically with medication)
- They can attempt to refer the patient to a mental health professional depending upon the severity and medication necessity of the patient
Unfortunately, PCPs don’t have the resources to effectively treat many mental disorders. And, given the relative mental and behavioral healthcare staff shortage, option number two may not be available. One group of researchers in Los Angeles County attempted to set appointments with psychiatrists across the county. They called each office and described themselves as an individual with a serious mental health condition. Of the 229 psychiatrists in the area, only 28 of them were taking new appointments — and the average waiting time to get into those appointments was over five weeks.
Obviously, there’s a problem with this traditional model — it leaves untreated patients. So, where do healthcare providers go from here? How can we disrupt the behavioral health system to be more efficient, holistic, and patient-centric? And how can we help every person get help with their behavioral or mental issues?
What Are Collaborative Care Teams?
At their core, Collaborative Care Teams are organized and productive teams of primary care providers, psychiatrists and other behavioral and mental health professionals who coordinate patient care in a hyper-structured environment. The backbone of any Collaborative Care Team is communication and teamwork. Instead of traditional roles where mental health professionals and PCPs exist in separate environments, Collaborative Care Teams come together under one common goal — improved patient health. And they facilitate that collaboration using a shared register and outcome-based treatment method.
Collaborative Care Teams follow six basic principles:
1. Patient-Centric Care
Both PCPs and behavioral health specialists (e.g., psychiatrists, behavioral health managers, therapists and others) collaborate together to facilitate patient care. Not only are you bringing primary care physicians and mental health professionals together under one roof, but these individuals share aligned goals and are targeting the same general patient outcomes. So, instead of having two separate patient interactions (e.g., the PCP interaction followed by the psychiatric interaction,) patients will have one congruent interaction with all layers of the Collaborative Care Team.
Typically, PCPs and behavioral health specialists will work together in the same location, and psychiatrists will provide case-load consultations and support. Variations of this model can also have psychiatrists outside of the system, but the alignment between PCPs and on-site behavioral healthcare specialists ensure patients are adequately treated until they may need psychiatrist intervention.
2. Role Clarity
One of the largest roadblocks to teamwork is role uncertainty. Everyone within the Collaborative Care Team should understand their roles and how they can contribute to patient care. Every expert involved in the process should add their own layer of value, yet they should all be working toward the same goal. The entire Collaborative Care Team staff should be dedicated to care coordination, and the PCP should be focused on team-based treatment as opposed to physician-based care.
In other words, everyone should understand their roles, but they should use those roles as part of the team to generate tangible value for patients. Experts should support PCPs, and care managers should institute treatment guidelines that are effective and role based.
3. Population-based Care
Another core tenant of Care teams is their ability to provide support via population panel management and shared records. Health records and mental health notes should be shared within the team, and standardized care steps should be utilized to ensure that each patient flows through the care framework. Outcomes for all patients should be tightly monitored, and referrals, lab work, and all of the other necessary treatment steps should be automated via policies and guidelines.
Teamwork is facilitated by shared information. Each member of the Care team should understand when and where they’re needed, and every team member should be able to track and monitor patient outcomes and treatment plans. This helps breed a culture of transparency within the team. Additionally, it encourages constant feedback and regular role intervention.
4. Collective Leadership
Collaborative teamwork within healthcare systems has been shown to decrease patient mortality rates and improve overall levels of patient care. For physicians, collaboration has also been shown to decrease physician burnout and increase levels of job satisfaction. The goal of Collaborative Care Teams is to lean into collaboration as a tool to increase patient outcomes and reduce physician strain. And that can’t happen without the right systems and software in place to accelerate that collaboration.
Team leadership needs to invest in information systems, data management systems, and billing systems to help breed collaboration and care reliability. This is a crucial component of Care teams. Leadership has to invest in systems. Instead of focusing on micromanagement, Care teams rely on leadership that monitors outcomes, provides critical top-level feedback, and facilitates care outcomes via software investments.
5. Evidence-based Outcomes
In Collaborative Care Teams, treatment should be measurable and based on up-to-date research. The value of Care teams is that each role is responsible for keeping tabs on research in their specific domain, yet they all collaborate and share this research broadly. In other words, roles are still personally responsible for their domains, but they are also responsible for sharing measurements and research to other team members to help clarify objectives and formulate best-in-class treatment options.
One of the most significant barriers to adequate care is volume-based billing. When PCPs and mental health professionals are held accountable on their volume of patients, their core incentives are to treat as many people as possible — not deliver the best care to each patient. Care teams are reimbursed for quality-of-care. Care teams should provide incredible care-centric results that generate valuable and highly-authentic health relationships with patients. And that starts by dismantling traditional accountability models and basing care around measurable outcomes and clinical findings.
As healthcare providers continue to struggle with identifying, treating, and overcoming mental health issues, many healthcare systems are beginning to redesign their entire mental health process. By breaking down the silos between PCPs and other healthcare professionals, Collaborative Care teams have presented a more robust and framework-driven mental health model. These teams serve to treat the whole patient in the most efficient way, leading to increased patient outcomes over time.