Reprinted from the Health District's quarterly publication mailed to district residents (Fall 2005)

Mind. Body.

Two words often used together, sometimes joined by a hyphen.

So in vogue is “mind-body” in today’s health-minded culture. Yet, traditional family doctors and mental health professionals have long recognized the connection between the two.

Treating body aches and pains is nothing new for physicians. But today, physical complaints in as many as two out of three patients who arrive on the doctor’s office doorstep stem from psychological issues, including depression, studies show.

“We heard from primary-care doctors in Fort Collins, and particularly those in clinics that serve low-income and uninsured residents, that there was a major need for assistance with meeting patients’ mental healthcare needs,” says Dr. Bruce Cooper, medical director of the Health District.

In response, the Health District partnered with Salud Family Health Center and Family Medicine Center to add  more mental health staff to work alongside medical staff in treating patients. This approach, known as integrated care, was implemented this year at both clinics. (See story at right.)

Integrated care is of particular interest to both clinics because they provide healthcare to low-income and uninsured residents, a group at greater risk for depression, anxiety and substance abuse issues.

A study at Grand Junction’s Marillac Clinic, which serves only low-income and uninsured patients, found that the percentage of Marillac patients with at least one psychiatric diagnosis was nearly double that of patients with higher incomes and insurance who go to their family doctor’s office.

“We attribute this to the cycle of poverty and financial distress,” says Dr. Steve Hurd, a psychologist and the clinic’s executive director. “A lot of people we treat don’t have hope about the future. They have chronic stress, are living from paycheck to paycheck. Frequently, they cope by resorting to alcohol or other substances.”

In 2000, with the help of a Robert Wood Johnson Foundation grant, Marillac began offering integrated primary care and mental healthcare that today serves as a model for Fort Collins and others.

“Our medical providers at Marillac were overwhelmed with mental health and psychosocial crises – people come in with a sore throat and an eviction notice in their hand,” Dr. Hurd recalls. “The medical provider would be treating a jammed finger and the patient would want to talk about everything else going on.”

Private practices not immune

The trend is evident to providers in private practice, too.

“We’ve definitely seen an increase in the number of patients who come in with psychiatric symptoms,” says Dr. John Bender, a Fort Collins physician with 14 years in practice.

Contributing to the trend, he says, are reduced stigma about mental health issues, a greater awareness by patient and doctor of help available, and heightened anxiety in patients living in a sometimes violent and unpredictable society.

Still, sorting out the root cause of physical symptoms is challenging.

“The symptoms do overlap. A person can feel fatigue because they’re depressed, but fatigue can also be because of an internal illness,” Dr. Bender says. “The patient can’t always tell the difference.”

Nor is it easy for doctors. A person who complains of chest pain might be experiencing stress, a heart attack, or both, he says.

Once a diagnosis is made, treatment for mind and body needs to occur simultaneously, providers agree.

“If I treat the physical disease – let’s say cancer – and do all the right things but I don’t recognize and treat the depression, we know that these people will live shorter lives,” Dr. Bender says.

One-stop healthcare preferred

Primary-care physicians today as opposed to 10 years ago are better trained to recognize mental health problems like depression. Combine that with advances making medications more effective and with fewer side effects and the result is family doctors who are more comfortable and able to treat mental health, says the Health District’s Dr. Cooper.

For patients, getting help for medical and mental health needs in one stop saves time and money.

“All these things put together make the primary-care doctor’s office the first place people often go for treatment of mental health issues,” Dr. Cooper says.

How integrated care works

“My definition of integrated care is that the providers use the same bathroom,” says Dr. Hurd, who is serious about the value of close work quarters at the Grand Junction clinic. “Providers need to see one another in the hallway for spontaneous consultations.”

What’s more, providers share a patient’s chart for recording physical and mental progress.

For Salud, integrated care will close the gap between when mental health services are offered to patients and when they’re delivered, says Dr. Doug Whitman, a pediatrician and the clinic’s medical director.

“Now, by having mental health workers in our own building or available by cell phone, we don’t lose people in-between,” he says. “We get people the help they need on the spot.”

Family Medicine Center gains access to a psychiatrist, two case managers and a substance abuse counselor who will enhance the collaborative care the clinic has offered since the 1980s, says Dr. Carol Pfaffly, director of behavioral medicine.

“The patients that we involve in this team approach report higher satisfaction with their healthcare,” says Dr. Pfaffly, a licensed marriage and family therapist who sees patients at FMC. “They feel cared for, understood, and they see us as a part of their social network.”

Value to the community

A team approach to treating the whole person — mind and body — promises immediate and long-term benefits, says the Health District’s Dr. Cooper.

“Patients will experience less distress, they’ll function better in their daily lives and will be more productive,” he says.

Once mental health and substance abuse issues are identified and treated, patients potentially may make fewer trips to the doctor for physical symptoms. This, in turn, can reduce healthcare costs, studies have shown.

In the case of Grand Junction’s clinic, reducing mental health-related visits to the ER saved the community an estimated $1 million in one year, Marillac’s director says.