When patients visit a doctor's office the care team gathers a classic medical history assessment that can include blood pressure, weight, diet, blood work, and family history. Patients often arrive with complaints around stomach problems, sleep, anxiety, and not having energy. So in addition to those medical-type questions, we also have to ask about relationships, work or studies, recent or drastic life stressors, self-care, and other daily behaviors. Sometimes we ask about past trauma or mood experiences.
These additional questions starts the foundation for integrated behavioral health (IBH.) Core components of IBH are training the teams to learn about and address mental health and physical health, to educate and support the patients directly, and finally to provide interventions.
Primary care offices typically employ trained professionals who want to help patients get better. When patients are not changing and especially when their health is worsening, there is a strong likelihood it's related to living unsatisfactory and unhappy lives. There is most likely some kind of psychosocial barrier getting in the way.
This is when the care team can step in with compassion and curiosity to see what's happening. Investing in this time early will save resources while improving outcomes in the long-term.
Healthcare for real change requires that behaviors change from all stakeholders. Team members' might have to change their own thoughts, actions, words, and habits just as much as patients require changing.
"The relationship is the therapy" - a common mantra in the therapeutic world. Any one of us can provide a caring relationship to initiate change.
Patient Validation and Education
Learning about the patient and their lifestyle is key establishing rapport and building relationships. Teams can collaboratively create a robust social history from each interaction they have with the patient. Teams can employ standardized screeners and protocol to assess patient stressors and anxiety and depression symptoms.
Then, with training, team members can provide basic education on what they may be experiencing. For example, they may receive a thorough explanation of their diagnosis in real-world language. It might be a discussion on the stigma of medication. It might also be the beginning of conversations on options and what to do next. Care teams don't have to do it all but integrated behavioral health asks that they do some part of emotional healing.
Direct services in-house or via referral
Providers working in-house might offer medications to address patient needs. Behavioral Health Specialists might provide brief therapeutic interventions. Other team members may provide warmth and support. I like to call integrated behavioral health short-term interventions in a long-term relationship. It may not feel like much int he moment but it can have a huge impact for patients.
When in-office support isn't enough, the team can provide referrals to trusted community members for long-term therapy. Communication is maintained with both the patient and therapist to provdie full team care.
If this sounds like a lot of work, it is. However, the investment in training, listening to each other, learning about barriers and providing the basic knowledge for change is tremendously helpful. The team is sharing the responsibility for the patient, which helps alleviate burn-out. The patient is hearing a consistent and caring message about their mental and physical health from their team. It's whole care for long-term outcomes and makes work fun.