BRINGING MENTAL HEALTH CARE TO RURAL COMMUNITIES

Alumnus John Miller, M.D. ’00, is the medical director of the Partnership Health Center in Missoula, Mont., where the collaborative care model is already having a big impact on the center’s work. Photo: Mary Jane Nealon, R.N.-CCP

One in two people in the U.S. lacks access to effective mental health care. In rural areas, the problem is even worse, compounded by geographic isolation, lack of insurance, shortage of specialists, and reluctance to seek care.

“A depressed person may not seek help,” says Jürgen Unützer, M.D., MPH, professor and chair of the Department of Psychiatry and Behavioral Sciences and director of the Advancing Integrated Mental Health Solutions (AIMS) Center. “If we focus only on the patients who come to a mental health specialist’s office for care, we won’t make a dent in the denominator, the population of people who live with mental health and substance-use problems. An accountable health care organization has to consider the denominator.”

Unützer and UW Medicine colleagues spend a lot of time considering this denominator. In fact, they tested, refined and confirmed the effectiveness of a collaborative-care model developed with the leadership of Wayne Katon, M.D., Res. ’79, UW professor in the Department of Psychiatry and Behavioral Sciences. This model has since been used to benefit thousands of people around the world.

In collaborative care, a team of primary-care physicians and mental health care managers work with a consulting psychiatrist to provide effective mental health care. When a screening reveals depression, the patient meets with a care manager — usually a nurse, a social worker or a licensed counselor — to create and initiate a personalized treatment plan. The psychiatrist and care manager regularly review patient progress and recommend treatment adjustments to the primary-care physician as necessary. The psychiatrist also consults directly with patients who need extra help either in person or via a televideo connection.

This model makes mental health care more readily available. And, because it’s provided in the primary-care setting, it can reduce some of the stigma often associated with seeking mental health care.

The AIMS Center has implemented the collaborative care model at several of the UW Neighborhood Clinics and partnered with Community Health Plan of Washington and Public Health of Seattle and King County in a Mental Health Integration Program, an effort that has reached more than 38,000 patients since its initiation in 2008. Last year, the AIMS Center brought the model to rural clinics in the five-state region of Washington, Wyoming, Alaska, Montana and Idaho as part of a federal initiative supported by the John A. Hartford Foundation and the Social Innovation Fund.

Partnership Health Center (PHC) in Missoula, Mont., is a Hartford-supported site that serves an urban-rural area with high unemployment and poverty. UW Medicine’s model is already making a difference. “Patients are showing goodresponse to collaborative care,” says Program Director Mary Jane Nealon, R.N.–CPP. “One patient told me, ‘I don’t want to go through another generation of trauma and depression in our family.’”

PHC’s medical director, John Miller, M.D. ’00, MPH, also has a positive report. “Now we have the staff resources to deliver care more personally, efficiently and cost-effectively. Collaborative care is having a big impact on our work, and everyone benefits,” Miller says.

Local and regional clinics are benefiting; global providers are decidedly interested. “Clinicians all over the world are asking us how to implement this model,” Unützer says. In response, the AIMS Center is developing a web-based automated program that can create a collaborative care plan and training program tailored for a clinic’s needs.

To date, Unützer and his colleagues have trained more than 5,000 clinicians in 1,000 practices in the U.S. and in Europe, Australia and Hong Kong — making UW Medicine a “go-to” global innovator in collaborative mental health care.

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