A growing number of people who are at risk for or are experiencing an alcohol or substance-use disorder never seek help. When they do seek care, it’s often not from an alcohol or substance abuse specialist, but rather their primary-care provider. Furthermore, research has shown that when left untreated, mental health or substance abuse issues contribute to high use of medical care and poorer health outcomes.
It has been noted that primary-care doctors’ offices are more accessible, less stigmatizing to many people with mental disorders, and less expensive for many patients (lower out-of-pocket costs). Primary-care providers also have asked for help with finding appropriate care for their patients with mental health and substance use issues.
Still, gaps in access to services exist in Larimer County, according to the Community Mental Health and Substance Abuse Partnership, one of whose key goals is to enhance the effectiveness of the primary-care setting for identifying and treating mental health and substance abuse issues by creating a fully integrated primary-care model. Through research and interviews, the Partnership found, for example, that people with Medicaid and people who have low income and no insurance had the least access to psychiatrists. Cost and restrictive insurance coverage for mental health were also identified as barriers to care.
The Health District of Northern Larimer County has a history of supporting efforts to improve access to care for its residents. An analysis in September 2003 by the Health District's medical director, Dr. Bruce Cooper, further identified the need for integrated primary care/mental health care in our community. At the direction of its Board of Directors in December 2003, the Health District began partnering with Salud Clinic and Poudre Valley Health System on developing a model for improving access to mental health care at two “safety net” clinics in the community — Salud Family Health Centers and Poudre Valley Hospital's Family Medicine Center. Today, the integrated care program provides services to established patients at the two clinics, which serve the bulk of the community’s low income and uninsured populations.
The program offers clinic staff the support for using best practices guidelines and mental health and substance abuse professionals (including a psychiatrist) to better improve treatment outcomes for consumers. It is based on other successful national integrated care models that fit our community.
Offering mental health care in primary care settings is designed to improve patients’ chances that their mental health and substance use issues will be identified early, properly diagnosed and treated appropriately either internally or through a referral to a provider in the community. Services that have been identified as most needed here are psychiatric consultation, medication management and care coordination.
For more information about this program, contact the Health District's medical director, Bruce Cooper, MD, MSPH, at (970) 224-5209.
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