Role of hospital systems in helping repair the broken mental health system

Dr. Thomas Young, Founder and Chief Medical Officer, nView Health - Print  | 

During Mental Health Month in May, I and the other leaders at nView Health declared that it is time to replace mental health awareness with mental health action.

This was not intended as a single-month mission. Rather, it is one that we believe must continue during the months and years ahead of us. We call on healthcare providers to have meaningful dialogue and make concrete changes to put the country on a path to repairing our broken mental health system. While all of healthcare must play a part in achieving this objective, hospitals have a particularly vital role.

Hospital responsibility
Hospital systems are one of the "doors" into our healthcare system, whether that's through outpatient clinics, rehabilitation services, emergency rooms, or any other pathway. Once a patient enters the hospital system, every person who touches that a patient has their own role in determining whether there is a behavioral health issue.

For example, hospital team members working in a rehab facility or physical therapy office should screen their patients for behavioral health issues, such as depression. If a patient is depressed, they are not likely to go home and perform their recommended exercises, and therefore they may not achieve desired results.

No matter where patients interact with a hospital, there is an opportunity to screen and evaluate them for behavioral health issues. This doesn't mean those performing the screening need to treat the patients for any such issues. Rather, it means hospital staff must know about screening, its importance, and when to do it, and then they must know how to help that patient achieve a level of accessibility to the behavioral health system.

Another reason hospitals play such an important role is that patients with the six conditions included in CMS's Hospital Readmission Reduction Program who have comorbid mental illness are 56% more likely to be readmitted 30 days of discharge1. Hospitals have a significant responsibility at discharge to evaluate their patients — whether that's through screening, interviewing, or some other manner — to ensure they are not discharging a patient who is significantly depressed or anxious. Why? If this is the case, the patient is likely either not to follow discharge instructions or become overly concerned about a symptom and return to the hospital. That has an economic effect on the patient and hospital.

Consider a patient with congestive heart failure (CHF) who is over 65 and on Medicare. They get discharged from the hospital. They're anxious and depressed, so they don't take their medicine and get readmitted within 30 days for CHF. The hospital will not get paid for that readmission. If a hospital documents too many of such readmission scenarios in a year, they will suffer an economic penalty from Medicare.

Implementing solutions
Hospitals should integrate behavioral health into an individual patient's medical and/or physical care. They must set up the means to perform initial patient screenings, and then they must set up mechanisms to deliver results of those screenings across the continuum of care to assist patients in getting to the next step for their behavioral healthcare.

Hospitals have so many opportunities to evaluate people with screening at multiple locations throughout the system and can easily do so with basic questions built into their workflow for a new patient or one returning for an evaluation. The screening data should become part of the patient’s medical record. For hospital systems that use an electronic health record (EHR) platform, having screening data available in the EHR enables primary care providers within the hospital system to access a referred patient’s mental health data to help the patient move into the appropriate care pathway. This is made possible simply through the information built into a hospital's existing overarching technology.

EHRs are intended to connect everyone together while supporting effective data and information transfer. Using an EHR should give hospital systems the power to do more around behavioral health — and do it easily.

Getting started
The good news is that hospitals looking to take action on mental health already possess some of the basic building blocks. In addition to an EHR (if used effectively), they have the staffing — the people who can create the interaction with the patient. Then it's a matter of bringing mental health squarely into play in every aspect of what the staff members do. That's the key.

To achieve this goal, a hospital must deliver internal education. For example, every staff member must be told that they have an opportunity to integrate behavioral healthcare into the physical health of patients at every level of the hospital. It's beginning to say to the healthcare team that they need to be concerned about their patients' mental health as well as their physical health in every aspect of what they do.

Hospitals must also give educational direction to staff for how to create follow-up pathways within their system and develop the comfort zones for staff to be able to ask the questions that will steer patients into those pathways. That's fundamentally the starting point for hospitals: to begin to integrate behavioral health into their thinking, planning, and all related discussions.

For example, let's say a hospital is going to create a new program for delivering better cardiac care to patients. Part of that planning must account for the mental health piece of the program on better heart care.

As another example, consider diabetes education programs. People with diabetes are two to three times more likely to have depression than people without diabetes.2 Discussions about diabetes education programs must also include discussions about mental health. In every encounter, that must be part and parcel of the program.

As a third example, consider patients in dialysis clinics. Large numbers of people in dialysis are depressed, anxious, dealing with underlying post-traumatic stress disorder, and struggling with other behavioral health disorders. In addition to the dialysis treatments, there must be a focus and emphasis on the mental health of these patients.

A critical takeaway here is the importance of focusing on behavioral health in every aspect of where a hospital provides service. It's training team members about what they should be looking for as potential warning signs. If a patient is not progressing or doing as well in achieving treatment goals as the team member hoped, they must know that behavioral health could be a reason why. Then they must understand how to integrate proper questioning about mental health to identify a potential factor(s). Such an ideology must be engrained in team members — that a patient's struggle may be linked to a situational, social, and/or emotional issue outside of the physical issue.

Beginning to discuss, understand, and assess those kinds of issues represents a significant educational opportunity for hospitals. Then it's a matter of taking action to deliver that education and truly integrate behavioral health into all of healthcare.

Behavioral health cannot be a secondary consideration. We must do all of this and do it all at once if we hope to achieve the necessary makeover our nation's mental healthcare system requires and our patients deserve.

Dr. Thomas Young, founder and chief medical officer of nView Health, is a board-certified family physician with more than 35 years of medical experience. He is responsible for working with the nView team of software technology experts, customers, and partners to ensure clinical best practices are incorporated into everything the company does. Dr. Young is a recognized thought leader in the fields of consumer-directed healthcare and population healthcare management and can often be found speaking on behavioral health podcasts and at industry events.

1. Benjenk I and Chen J (2018) Effective mental health interventions to reduce hospital readmission rates: a systematic review., accessed 06/14/21
2. Centers for Disease Control and Prevention (2021), Diabetes and Mental Health., accessed 06/15/21

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