Literature Collection

Despite pronounced disparities in mortality and physical health outcomes, no well accepted models exist for integrating primary care with behavioral health for patients with serious mental illness (SMI). This article describes a case study of an enhanced approach to primary care that builds on the patient centered medical home (PCMH) model and adds three additional components: (1) longer and more frequent visits to establish trust and increase adherence, (2) a primary care team that has both the skills to provide effective primary care and the heart to take care of patients with SMI and (3) planned and proactive communication between the behavioral health team and the primary care team.

Mental health comorbidities are highly prevalent and problematic in epilepsy, making it important for neurologists to be equipped to manage their patients' mental health concerns. This article explores the paradigm shift toward integrated mental health care approaches, aiming to educate early-career neurologists on their role within epilepsy care. We focus on depression and anxiety, how they present in epilepsy, and the role of integrated mental health care in managing these comorbidities. Key areas include the neurologist's role in identifying mental health issues through patient discussions and screening tools, and the basics of neurologist-led management. This covers the selection and adjustment of antiseizure medications and the use of psychopharmacology. Additionally, we emphasize the importance of providing psychoeducation and promoting healthy lifestyle choices that support mental well-being. Finally, we discuss the neurologist's role in facilitating referrals to mental health specialists, including information about the role of psychological interventions and psychiatry. This article aims to provide foundational knowledge to encourage early-career neurologists to actively engage in integrated mental health care approaches with their patients. This care can be flexible in how it incorporates different modalities and is tailored to local resources. It does not have to be extensive but should be meaningful enough to identify mental health concerns and facilitate patient access to appropriate resources and care.

Office-Based Opioid Treatment (OBOT) with buprenorphine has been available since 2000; however, many barriers to OBOT within primary care exist, and only 3.6% of family medicine physicians are waivered to prescribe buprenorphine.1 We have successfully integrated OBOT into our primary care practice, expanding access to treatment for opioid use disorder.

To address shifting demographic trends in health care, this guide offers an approach to defining the needs of members with limited English proficiency and developing strategies to meet their communication needs.

Background/Objectives: People with a severe mental illness die much earlier than the rest of the population from a preventable physical illness. Annual health checks are a way of assessing the person to then offer the appropriate interventions. Integrated Care Northampton, England used the long-term plan baseline funding allocated to them from the government department that commissions primary care services, to implement a local enhanced service. Their aim was to provide a person-centred physical health check that people with severe mental illness feel comfortable, confident, and able to engage with. Methods: Wellbeing Organisation Research Training Hub Northampton were commissioned by Integrated Care Northampton to provide training, support, and evaluate the locally enhanced service. Training was provided by training trainers who then offered one-to-one support to those delivering health checks in practice. Providers of the health checks could also access individual support from Wellbeing Organisation Research Training Hub staff. Patient data were collected via a template that is part of usual practice. Questionnaires were used to evaluate the education of staff, the delivery of health checks, and the impact on people with severe mental illness. Results: Training was well received but most of the trainers did not continue in their role. The project was successful in highlighting the physical health needs of people with severe mental illness and monitoring in primary care increased. Though methods were put in place to evaluate the delivery of health checks and their impact on people with severe mental illness, these were not utilised by the service. Conclusions: This paper emphasises how difficult it is to implement a new service and evaluate it successfully. Future projects should prioritise measuring the quality of the service.

BACKGROUND: Numerous US patients seek the hospital emergency department (ED) for behavioral health care. Community Health Centers (CHCs) offer a potential channel for redirecting many to a more patient-centered, lower cost setting. OBJECTIVE: The aim of this study was to identify unique market areas serviced by CHCs and to examine whether CHCs are effective in offsetting behavioral health ED visits. RESEARCH DESIGN: We identified CHC-year specific service areas using patient origin zip codes. We then estimated random effects models applied to 42 federally qualified CHCs operating in New York State during 2013-2020. The dependent variables were numbers of ED mental health (substance use disorder) visits per capita in a CHC's service area, drawn from HCUP State Emergency Department Databases. Key explanatory variables measured CHC number of mental health (substance use disorder) visits, number of unique mental health (substance use disorder) patients, and mental health (substance use disorder) intensity, obtained from the HRSA Uniform Data System. RESULTS: Controlling for population, we observed small negative effects of CHC behavioral health integration in explaining ED behavioral health utilization. Measures of mental health utilization in CHCs were associated with 1.3%-9.3% fewer mental health emergency department visits per capita in Community Health Centers' service areas. Measures of substance use disorder utilization in Community Health Centers were associated with 1.3%-3.0% fewer emergency department visits per capita. CONCLUSION: Results suggest that behavioral health integration in CHCs may reduce reliance on hospital EDs, but that policymakers explore more avenues for regional coordination strategies that align services between CHCs and local hospitals.