As a primary care provider, it has become apparent to me that we need to shift how primary care is structured by expanding our role in early identification of behavioral health concerns (mental health and substance use).
The core of primary care is preventive care. That perspective needs to include actively identifying behavioral health and well-being issues as a fundamental part of the delivery of primary care.
As physicians, we cannot treat patients effectively when we do not know what may be impacting or even impairing our patients’ health. The stigma behind behavioral health needs to be eliminated. Behavioral health needs to be fully part of our preventive primary care approach so we can provide better treatment with better health outcomes.
The recent series of stories around youth suicide prevention in the Durango Herald was an encouraging beginning in the education of our community. The stories shed light on local resources to combat increasing suicide trends and the tragic impact on families, friends and the community.
As a family physician who has practiced in Durango and Cortez for the past 14 years, I know that primary care providers can be the first line of defense for patients who are experiencing behavioral health issues. National studies indicate that primary care providers respond to 80 percent of identified behavioral health treatment needs; but this percentage doesn’t address patients’ needs that are not identified.
We need better screening and more aggressive integration of behavioral health and medical care to provide better comprehensive care. We need to change our approach to healing our patients and communities, both nationally and here in Southwest Colorado.
After the Aztec school tragedy, a patient receiving care at the local VA clinic said to me, “We all need to do all we can to help our communities heal and prevent these tragedies.”
This comment resonated with me as a physician, and I started to evaluate how I could improve my role in caring for my patients and community. I decided I wanted a more active role in changing how care is delivered by connecting behavioral health screening, identification and appropriate interventions into my practice.
As a result I decided to change jobs, and I recently accepted the position as medical director at Axis Health System.
This work allows me to be involved in how primary care is designed and delivered at our five primary care clinics: La Plata Integrated Healthcare, Cortez Integrated Healthcare, Archuleta Integrated Healthcare, and School-Based Integrated Healthcare clinics at Florida Mesa Elementary and Durango High School.
At these clinics, it is our standard practice to screen all patients for a broad variety of health conditions to better identify both the known and unknown issues that may be affecting a patient’s health, including screenings for anxiety and depression.
The care at these clinics is delivered by a “care team pod” that includes access to a therapist, psychiatrist and a primary care provider. Together, they are available to design the right care plan to address the health needs of each patient.
This is a bold new approach to delivering care that supports the providers in engaging the patients early on. It gives them the ability to adapt care to more effectively address the patient’s whole health needs.
I believe changing the resources and care delivery in the primary care clinic can truly impact the care gaps that exist. It can also reduce barriers to providing better, more comprehensive preventive healthcare.
As a father, physician and neighbor, I invite you to see primary care as something broader than it has been in the past. Healthcare can be – and needs to be – different and better. Early identification of physical or behavioral health concerns is key to avoiding a crisis or tragedy.
If we think about health differently, together we can make a difference in our community.
Dr. Luke Casias is the Medical Director of Axis Health System integrated healthcare clinics in Durango, Cortez and Pagosa Springs.
