Integrated care

On June 1, the Herald ran the final story in a series of three (from Rocky Mountain PBS I-News) on mental illness. It was filled with painful examples that I have seen throughout my more than 30 years of operating mental-health treatment programs. Yet, what was most painful was it was incomplete and, in its own way, contributed to the stigma that leads to the very problems noted in the story itself.

It is not that the story was wrong in its facts, but rather in its focus and implications. The reader is left believing care by a psychiatrist is the only care, the solution is more state hospital beds and all care – and hence all care gaps – exist evenly throughout the state. None of these “implications” are, in fact, true.

There are too few psychiatrists in Southwest Colorado and across the state, yet psychiatric services (largely the prescribing and monitoring of medications), while a valuable part of treatment, are not adequate in and of themselves. Psychiatric services in the context of treatment provided by psychologists, social workers and other trained professionals have, until recently, proved most effective and allow treatment to be more immediately available. What we are coming to learn recently is that models that treat mental illness separately are less effective than treating these issues in the context of whole person health care.

Largely because of stigma, mental health care is universally delayed and often sought only after the person’s condition has become so severe as to significantly impair their lives or pose a risk to others. Yet, even in these situations, in-patient hospitalization is not always the best and most effective answer. In 2006 here in Southwest Colorado – through a unique partnership of all five counties, municipalities and hospital districts – Axis Health System established and currently operates the Acute Treatment Unit on the Mercy campus, the first such licensed unit in Colorado. Axis now addresses more than 90 percent of emergency calls without the need for an in-patient hospitalization on the Front Range or in Grand Junction by wrapping services around the individual and family or through a short stay at the ATU – close to family, friends and support systems. Though necessary in certain situations, emergency services are like an ambulance service at the bottom of the cliff, which is why we focus on early identification of problems at more treatable levels and the need for a better understanding in our community of mental illness as a health-care issue.

Mental-health first aid helps our community at large gain a better understanding of mental illness and how to respond to it. Axis has provided many mental-health first aid trainings in our communities and is available to do so for any group that is interested.

Axis partnered with the Durango chapter of the National Alliance for the Mentally Ill to bring the third Crisis Intervention Team in the state and the first in the entire country in a rural setting to Southwest Colorado. This more intensive training program for law enforcement officers has made a huge difference in how law enforcement responds to mental-health crises and more effectively resolves them. Kudos to the Durango Police Department, La Plata County Sheriff’s Office, Linda Lute and Lauren Patterson for leading the ongoing development of CIT and annual training.

School-Based Health Centers, partnering with District 9-R schools, have had a huge effect on our community. The two school-based health centers have helped keep our kids healthy and helped countless children and adolescents address major issues in their lives constructively with the least trauma, heading off far more serious problems.

Through all of these efforts, the need for hospitalizations has reduced from 122 across the five counties of Southwest Colorado in 2001 to 40 in the past 12 months (a 77 percent reduction), despite the fact our region’s population grew 15 percent over that same time.

To reduce crises and improve care throughout Southwest Colorado, Axis has been transforming from its historic role as a community mental-health center to an integrated, whole person, primary health-care system. By caring for persons, not just treating illness, and by treating the whole person, we are reducing stigma and supporting the early identification of all chronic illnesses while also supporting healthier lifestyles and more sustainable health outcomes.

In Southwest Colorado, integrated care and early identification of health-care problems, including mental health, is not coming tomorrow – it is here today.

Bern Heath is the chief executive officer of Axis Health System in Durango, a private nonprofit and the state-designated mental health resource for the five counties of Southwest Colorado.

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