The Affordable Care Act (ACA) is an expansive legislation that goes far beyond insuring the uninsured and healthcare.gov. One of the key goals of the ACA is putting medical care and mental health care on a more equal footing, along with integrating these services where and when possible. Marcia Mead and Holly Hughes, Medical Director and Behavioral Health Director, respectively, for the Santa Cruz Community Health Center (SCCHC) formerly the Santa Cruz Women's Health Center in Santa Cruz, CA, say the benefits of serving patients this way are quantifiable and easy to appreciate.
“I now can see and help many more people in the course of a day,” said Hughes. “I can step into the exam room on an as-needed basis, at the invitation of the primary care physician, and help with a crisis or an intervention. We couldn’t do that before. Now my day is usually eight to 12 regular therapy sessions and two or three ‘step ins.’” Sometimes psychotherapist Hughes speaks with the patient at that time, or she may discuss setting up a consultation in the future. That is called a ‘warm handoff.’
“If the patient is crying or upset, I can go get the behavioral health provider,” said Dr. Mead. “The stigma of mental health treatment is evaporating. If they have general depression or an anxiety disorder, or are facing a major life crisis (e.g., maybe struggling with addiction), we can work with behavioral health providers and get them involved immediately. It is much more effective that way. The goal is to reach the whole person and many have behavioral health issues.”
What makes it work is effective communication. “We are now in constant communication,” said Hughes. “We can send medical records electronically with notes. It is exciting to break down structures and give better care. It is valuable to have that immediate resource. I am much more aware of physical causes, such as hypertension, from working closely with their physician. Working this way helps us keep the focus on moving forward with providing care.” Dr. Mead finished Hughes’ thought: “When I see somebody, I’m thinking ‘How can I get Holly involved?’” Working in close conjunction can also help keep health care costs down by applying the appropriate therapy immediately, without further consultations required.
A behavioral health intervention typically is more effective if the patient is willing to make the first step toward finding a solution. “This intervention, the way we work now, comes toward the person. They get access to care. We get better at caring for the underserved,” Hughes concluded. Dr. Mead said, “Almost everyone in poverty has psychosocial needs, and now we are able to treat them in a timely and efficient manner.”
ACA also resulted in the Santa Cruz Community Health Center expanding in order to respond to growing community needs, including the increased demand for primary care. They opened a second clinic that offers healthcare services to children and men, in addition to women. The project was in partnership with Dignity Health Dominican Hospital, Sutter Maternity & Surgery Center, and the Palo Alto Medical Foundation Santa Cruz.
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