On January 8, 2015, SETMA published a review of our 2014 achievements comparing it with out stated goals for 2014 which were published in December, 2013.  The review showed that we had accomplished all of our goals for 2014.  We included in that review our goals for 2015. Chief among these is for us to expand our Behavioral and Mental Health services to our patients as a part of the patient-centered medical home model of care.

As first steps in this process, SETMA has recruited a Psychiatrist, who will join our practice in May, 2015.  In addition, SETMA will be partnering with the Counseling Department at Lamar University to incorporate behavioral health specialists into all SETMA clinics.  SETMA has also  formed a Behavioral Health Team which will be led by

• Dr.  Absar Qureshi, Medical Director of Behavioral and Mental Health. He is an Internist and a trained Psychiatrist
• Dr.  Dona Keith, Director of Behavioral and Mental Health.  Dr. Keith  is a Psychiatrist and will be in charge of the development of the department.
• Ms. Pat Crawford, Director of Care Coordination.  Ms. Crawford was the administrator of a psychiatric practice for 20 years and for five years has been Director of SETMA's Department of Care Coordination.
• Carl Sheperis, PhD, Chairman of Lamar University's Department of Counseling and Special Populations.  He is collaborating with SETMA to integrate behavioral and mental health care into our PC-MH.
• Other members of SETMA’s team will actively work with the Behavioral Health Team.

Behavioral health is a term that covers the full range of mental and emotional well-being - from the basics of how we cope with day-to-day challenges of life, to the treatment of mental illnesses, such as depression or personality disorder, as well as substance use disorders and other addictive behaviors.

While they are not precisely synonyms, behavioral health and mental health are functionally the same.  The following is a published description of mental health.  It is a level of psychological well-being, or an absence of a mental disorder; it is the "psychological state of someone who is functioning at a satisfactory level of emotional and behavioral adjustment." From the perspective of positive psychology, mental health may include an individual's ability to enjoy life, and create a balance between life activities and efforts to achieve psychological resilience.

According to the World Health Organization (WHO) mental health includes "subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others.: WHO further states that the well-being of an individual is encompassed in the realization of their abilities, coping with normal stresses of life, productive work and contribution to their community. However, cultural differences, subjective assessments, and competing professional theories all affect how "mental health" is defined.

A person struggling with his or her behavioral health may face stress, depression, anxiety, relationship problems, grief, addiction, ADHD or learning disabilities, mood disorders, or other psychological concerns. Counselors, therapists, life coaches, psychologists, nurse practitioners or physicians can help manage behavioral health concerns with treatments such as therapy, counseling, or medication. The new field of global mental health is "the area of study, research and practice that places a priority on improving mental health and achieving equity in mental health for all people worldwide."

Behavioral Health Professional

This includes the following, those who are who are licensed by the state, whose professional activities address a client's behavioral issues; examples include psychiatrists, psychologists, social workers, psychiatric nurse practitioners, marriage and family counselors, professional clinical counselors, licensed drug/alcohol abuse counselors and mental health professionals.

SETMA’s Behavioral Health Department

SETMA has been actively involved in Behavioral and Mental Health since its founding but previously that involvement was not in a structured way.  We have developed the following tools for helping us achieve effective Behavioral intervention with our patients.  Simply the use of these tools will not fulfill our behavioral health goals.  However, their use and the incorporating of behavioral and mental health evaluation and discussion in a patient-centered conversation during a healthcare encounter will. 

SETMA’s Behavioral Health tools can be reviewed on our web site at EPM (Electronic Patient Management) - under the drop down menu Behavioral Health where the currently existing tools are displayed:

Tutorials and explanations of these tools can be accessed at www.jameslhollymd.com with the following links:

• Adult Weight Management Tutorial
• Annual Questionnaires: Fall, Functional, Pain, Stress, Wellness
• Depression Tutorial
• Fall Risk Tutorial
• Health Insurance Portability and Accountability (HIPAA) Privacy Tutorial
• Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive
• LESS Initiative Tutorial
• Medical Hone Transtheoretical Model Assessment Stages of Change Tutorial
• Pain Management Tutorial
• Reduction of Antipsychotics Toolkit
• Smoking Cessation Tutorial
• Stratifying End-of-Life Risk for Hospice Services Tutorial

With the development of Behavior Health, SETMA is examining the following, as some of the measures we will use to judge our progress:

1. When a patient's Stress Assessment shows significant stress are they referred to a mental health worker for further assessment and therapy?
2. When a patient has a diagnosis of depression does their supply of medication meet the HEDIS standard for this metric?
3. When a patient has a diagnosis of a major depressive disorder, bipolar disorder, schizophrenia, etc. do they have at least an annual medication review and appointment with a psychiatrist or a psychiatric CFNP?
4. When a patient has an acute behavioral or mental health issue can they be seen by a mental heath worker within 24 hours?
5. Are mental health and behavioral health issues addressed and documented in the EHR at each visit? 
6. Is there a plan in place for behavioral health and or mental health for uninsured, under insured and for patient's who cannot afford co-pay?
7. Do all health care providers and nurses have annual training in improving sensitivity, skill and treatment of behavioral health and mental health conditions for a minimum of three hours?
8. Does the practice have a plan in place to comply with Federal and State HIPAA Privacy standards for assessment and treatment of mental and behavioral conditions?
9. Does the practice have a policy and plan in place which they follow for patients with narcotics, and other potentially dangerous drug, monitoring?
10. Does the practice audit charts for patients on psychotropic medications to make certain that each such patient has at least one diagnosis which justifies the medication, particularly in long-term residential care?
11. Does the practice have a published algorithm for number 9?  Is it followed?

In coming weeks, we will discuss more about Behavior and Mental Health care in the patient-centered medical home model of care.