UC Davis Train New Trainers (TNT) Primary Care Psychiatry (PCP) Fellowship
Primary Care Providers Go Back to School to Integrate Behavioral Health
It’s perhaps a bit of a myth that California has one, overarching “healthcare safety net” that serves our low-income and uninsured residents. In reality, what we have is a combination of several healthcare safety nets: one for primary care, one for mental health care, and one for substance-use treatment.
This patchwork system hasn’t worked well for patients. A recent study suggests that less than a third of the individuals who suffer from depression actually receive treatment for it, with low-income patients, racial and ethnic minorities, men, and uninsured adults even less likely to get the help they need. These findings are similar to those collected in a 2014 Foundation-funded survey of low-income Californians’ experiences with behavioral healthcare.
To overcome these challenges, safety net leaders across California are developing new approaches and solutions to behavioral health integration that can meet the needs of patients along the continuum. In Alameda County, for example, Foundation funding is helping to enable a strong cross-system collaboration between the county health services agency, the county behavioral health agency, and the Community Health Center Network, a consortium of Federally Qualified Health Centers (FQHCs). Their joint efforts include improved data-sharing between county behavioral health and FQHCs, clearer guidelines for prescribing psychiatric medication between primary and specialty care, and the deployment of county psychiatrists to FQHCs for consultative sessions with primary care providers.
This fall I had the opportunity to learn about another unique approach the Alameda County collaborators are testing from the perspective of a group of physicians and nurse practitioners participating in a UC Davis Train New Trainers (TNT) Primary Care Psychiatry (PCP) Fellowship.
The providers enrolled in the program receive training from experienced psychiatrists on how to diagnose and treat substance use and mental health conditions and more effectively respond to their patients’ behavioral health needs within the primary care setting. They also learn how to build better relationships with their patients through techniques like motivational interviewing and cognitive behavioral therapy.
During the one-year fellowship, participants acquire roughly 50 hours of training through a mix of weekend sessions, one-on-one mentoring, and patient case-study discussions. Though it does require some time spent away from clinical practice, the fellows note that it is worth the benefit and essential to their growth, engagement, and success.
It’s clear that the training is already paying off. Participants have gained confidence in their ability to respond to and support patients with a range of conditions behavioral health conditions, and in areas where they used to shy away, they now step up.
Ameneh Moghaddam is a nurse practitioner at Axis Community Health. She says that before this program, she was scared to prescribe medication for mental illness. That discomfort made it hard for her to fully help her patients who suffer from PTSD, especially those from war-torn countries like Afghanistan and Yemen.
Now instead of feeling scared, Moghaddam says she feels “awesome.” “I am prescribing antipsychotic medications I have never touched before and that I never knew anything about before.”
Dr. Parveen Kaur, MD from Tiburcio Vasquez Health Center went through a similar transformation. “Before the start of the program I was nervous with even depression and anxiety. Now, I don’t worry so much about anxiety and depression. I look forward to more complicated patients.”
The transformation goes beyond just feeling more comfortable with diagnosis of mental illness and managing medications better. Dr. Lisa Yee, MD of Asian Health Services says the training helped her to be more “empathic and compassionate” when she treats patients diagnosed with serious mental illness.
Early feedback from participants suggests that the extra training can mitigate burnout. Rita Davis-Marten, a nurse practitioner at West Oakland Health Council, reported that her new skills and confidence means that she has more energy for her patients and herself. “It has reduced my fatigue. I feel less drained after a visit.”
One reason why the training may work so well is that the co-directors of the fellowship - Robert McCarron, DO and Shannon Suo, MD - are board certified in psychiatry and internal/family medicine, bringing perspective and understanding from both sides. As a result of their on-the-ground experience and expertise, the program is designed in a way that enables fellows to easily translate their learning into practice.
While participants report that they’re now more comfortable addressing the full spectrum of mental and physical healthcare needs of their patients, it may take more time before they feel confident enough pass on this knowledge and teach their colleagues – another hoped-for aim of the program as it continues to evolve.
Driven by their success to date, the Fellowship has recruited providers for the Class of 2017, and is generating ideas for expanded areas of focus, such as pain management and addressing the racial and ethnic disparities that impact access to behavioral healthcare.
I remain inspired by the fellows and the ongoing will of local communities to improve the way that we treat and heal whole people – mind, body, and soul.
Ultimately, integrating mental and physical healthcare is not about creating an entirely new system; it’s about connecting and strengthening the leaders, resources, and systems that we already have in place. The work underway in Alameda County – and in many other regions all across the state - is proof that strong cross-system collaborations can surface the kinds of solutions that will bring us closer to one, cohesive safety net in California.
For more, see our page on Improving Behavioral Health Care for Low-Income Californians.