Mental Health Integration at Intermountain Healthcare, UT

Mental Health Integration at Intermountain Healthcare, UT

 
 

 

Background & Goal

Approximately 73% of patients seeking primary care have a psychological or behavioral health component connected to their chief complaint, and that percentage increases for patients with a chronic disease. When Dr. Reiss-Brennan opened her independent nursing family therapy practice in 1978, she received a regular stream of patient referrals from primary care providers uncertain of how to address their patient’s mental health needs. In 1984, to respond to this gap in care, Dr. Reiss-Brennan developed a collaborative, innovative business model to train primary care providers/clinics in mental health care and family systems concepts.

Dr. Reiss-Brennan’s innovative mental health integration care model caught the attention of Intermountain Healthcare (IH), and in 1998, Dr. Reiss-Brennan’s care model was coupled with a model on chronic medical diseases to lay the infrastructure for Mental Health Integration at Intermountain Healthcare, Utah (MHI). Through this pilot integrated care model, depression, substance abuse, anxiety and other mental health conditions were managed in IH primary care settings alongside other chronic conditions. In 2001, following the extremely positive outcomes of the pilot program, IH requested Dr. Reiss-Brennan to join their team and diffuse MHI throughout the entire delivery system.

The MHI model of care is designed to promote three essential primary care practice changes: 1) improve the detection, monitoring, stratification, and management of depression and other mental health and medical conditions; 2) reinforce ongoing relational contact with patients and their families to promote adherence and self-management; and 3) match and adjust treatment and management interventions if there is evidence of increasing complexity and/or inadequate patient response. The broad goal is to involve the patient and family in their own care and to enhance their self-management skills.

More Information

Brenda Reiss-Brennan, PhD

APRN Mental Health Integration Director
Intermountain Healthcare
36 South State Street 
Suite 2100 
Salt Lake City, Utah 84111 
801-442-2990  
Brenda.reiss-brennan@imail.org

One Page Summary

Program Description

Mental Health Integration at Intermountain Healthcare is an evidence-based, team oriented, care process that develops a family-centered care model aimed at improving mental health treatment within primary care settings. MHI re-engineers the primary care process by including peer advocates, patients, and families as integral members of the team.

MHI developed screening materials completed by each patient, as well as an interagency referral algorithm, that assures the patient is engaged at the level of care required to meet their mental and physical health needs. Team resources are allocated to meet the complexity (mild, moderate, severe) of the patient and family identified need. Team communication and coordination are further facilitated through shared electronic medical records, clinic based nursing care managers that follow patients’ progress, and patients having direct phone and email access to their physicians and team members.  MHI’s team based care has been sustained throughout the life of the program and has changed the culture of mental health care delivered at Intermountain.

Evidence of Success

  • Over the last 15 years MHI’s care model has been implemented in over 90 of the 160 IH clinics (including primary and specialty care clinics and community based clinics for low income families).
  • MHI has also been influential in disseminating the implementation science of clinical integration in Maine, Mississippi, New Hampshire, Oregon, Arizona, Utah and overseas in France, the UK and Singapore.
  • Patients with depression who are treated in MHI clinics are 54% less likely to have emergency room visits than depressed patients in non-MHI clinics.
  • In 2010, patients with depression who were involved with an MHI clinic saw their health insurance claims decrease by $667 in the year following their diagnosis.
  • Diabetic patients with depression gained better control of their diabetes (53.1% v. 47.5%), and 81% of patients recently surveyed said they were hopeful they could get well or stay well.

More recently, Dr. Reiss-Brennan and her research team at IH study had the opportunity to measure the longitudinal impact of routinized MHI-Team Based Care (TBC) on clinical and financial outcomes and to quantify the value of integrating mental health as an organized team process within the context of primary care medical homes. IH Researchers observed that sustained levels of routinized TBC, as opposed to traditional practice management, were associated with significant improvements in quality of care, reductions in acute care utilization and overall costs. These findings suggest that patients who have continuous, coordinated relationships within a delivery system that provides care through high performing integrated clinical teams connecting physical and mental health receive value in improved outcomes and lower costs.