Integrated care: connecting medical and behavioral care | Tom Sebastian | TEDxSnoIsleLibraries


Translator: Napakcha P.
Reviewer: Peter van de Ven Shortly after my 40th birthday, I got in the car and merged
onto the highway on the way to work. And suddenly my heart was pounding and my chest was tight and I couldn’t breathe. So I pulled off to the side of the road, I made a quick phone call
to my wife Sherrie and left her a brief message
that I loved her, and then I called 911. A short time later the paramedics arrived, and they loaded me onto the ambulance, and they put nitroglycerin
under my tongue. Nitroglycerin. I thought, “Wow!
They must think I’m dying too.” So they loaded me into the ambulance, and they took me
to the local emergency room. The emergency room doctor there
ran a number of tests, and she came back and said to me, “Not really sure what’s going on with you, but you don’t seem to be
in any immediate danger.” And so I was discharged from the hospital with a number of referrals for follow-up. And so then, over the next several weeks, I saw a variety of specialists, received a variety of diagnoses, was started on a variety of medications to treat everything
from heart disease to acid reflux. And then, a couple months later,
it happened again, but this time I was able to immediately
get in to see my longtime doctor. So he sat me down, and he said, “Tom,
there is nothing wrong with your heart. What’s going on with you?” And after a conversation about everything
that was going on in my life in that time, he gave me the correct diagnosis
of having depression and anxiety, and it was manifesting itself
in these terrible anxiety attacks that were making me feel
like I was dying. I was really lucky. I’m a mental health professional. I went to my medical provider
thinking I had a medical condition, but he saw the larger picture. He saw me as a whole person, and he was able to identify
[that] what I was facing were challenges related to my mental
and emotional wellbeing. Unfortunately, this is
not the norm in our country. The medical, mental health and
addiction treatment systems are existing in these separate silos and they’re creating this fragmented,
difficult-to-navigate maze, a game of hide-and-seek in order to find the care
that one really needs. This leads to overly narrow diagnoses and at times really
bad outcomes for folks, where they end up in
emergency room hospital beds and other institutional settings
at the highest cost and likely the least effective
treatment in the long run. So, to see how this
plays out in real life, let’s follow the story of Emma,
who’s in fourth grade. Emma’s teacher expresses concerns that she’s often absentminded
in the classroom, at times she’s falling asleep, and she’s making frequent visits
to the school nurse with a variety of complaints
of aches and pains. Emma takes her to the doctor. Her doctor, after a brief visit,
gives her a diagnosis and sends her home, likely without having evaluated
or treated all her needs. So how does that play out for Emma? Continued difficulty in the classroom, maybe getting in trouble at school
leading to tension at home, adding to the stress of whatever
she’s already trying to cope with. That’s an example of how the fragmented
healthcare system is failing us. But, thankfully, this is changing. We’re changing the way we’re caring for people’s mental
and emotional wellbeing as well as our physical health. We’re recognizing that
mental health conditions and addictions are genuine health conditions,
just like heart disease or diabetes. And this shift is laying the platform
to move away from this fragmented system to one that is more integrated
and treats the whole person. It’s leading to
integrated care experiences. So how would this change for Emma? Emma’s mom takes her to the doctor, the doctor now realizes “Wait a second, there’s more going on here
than just a physical illness.” Emma and her mom
are able to go down the hallway and make an appointment
with a social worker, one that specializes in working with kids. And that social worker
is able to take the time to make a full assessment
of all of Emma’s needs. Now, the social worker,
the doctor, Emma and her mom are able to work together
to create a care plan that addresses all those needs. This is an example of how an integrated care approach
can be transformational in the lives of those that we serve. There’s another innovation
I want to share with you. It’s the growing recognition
in the healthcare system that unless one’s basic needs are met, good overall health
is very difficult to achieve. We refer to this as
the social determinants of health. You may be familiar
with Maslow’s Hierarchy of Needs. Developed by Abraham Maslow, this well-accepted theory maintains
that unless one’s basic needs are met, it’s hard to achieve those higher-level
goals and aspirations in your life. The social determinants of health
is a similar theory, that maintains that
unless one’s basic needs are met, good overall health, again,
is very difficult to achieve. Simply put, it means that if people don’t have
a decent affordable place to live, access to adequate amounts
of nutritional food and other basic needs met, all the best care in the world
may not make a difference. What if Emma and her mom
are living in a homeless shelter or in their car? What are the medical and behavioral health
providers supposed to do about that? I’ll tell you what. Increasingly, medical providers
and behavioral health providers are partnering together
with social service providers in order to develop
comprehensive care plans. I mean, now we’re really
getting at somewhere, not only having Emma’s medical
and behavioral health needs met, but also her basic needs, and everybody working together as a team on her behalf. There’s a movement going on
around the country and here at home where medical providers are increasing
their ability to identify and assess the behavioral health needs
of those that come to them for care. Also, they’re increasing their ability to provide treatment
for those behavioral health needs. Coinciding with those changes are changes that are happening in
the behavioral health system, where behavioral health providers are increasing their ability
to recognize the medical conditions of those that come to them
for behavioral healthcare. And they’re increasing their ability
to treat those needs, either within their own practices or in partnerships
with other medical providers. And so you can begin to see we’re trying to aspire to create
this no-wrong-door system in order to get the care
that’s required for your whole person. It’s estimated by the
American Psychiatric Association that one-third of all adults
that are receiving medical care also have a behavioral health condition
such as depression or anxiety. If there are 300 of us here today, that means a hundred of us
are facing these challenges; a third of the neighbors
in your neighborhood; a third of the students in our schools. Additionally, 70% of people who are
receiving behavioral healthcare also have a coinciding medical condition. This can range from
persistent headaches to insomnia to more chronic conditions,
such as diabetes. And guess what: an integrated care
approach will not cost more money. In fact, we think it will not only
dramatically improve care, but it will do so at a lower cost. It’s estimated that
an integrated care approach will save commercial insurers
Medicaid and Medicare 26 to 48 billion dollars a year,
just in our country alone. How is this possible? Well, it’s possible because when people
get all the care they need, when they need it, in the communities in which they live, they’re able to avoid those
higher cost stays in emergency rooms and hospital beds
and other institutional settings, again, likely at the least effective care
for them in the long run. We can do so much better for those of us that have heart disease
and also suffer from depression. And we can do so much better for those of us
that face mental health challenges and need specialized assistance in order to care
for conditions such as diabetes. And we sure don’t need nitroglycerin
to be put under our tongue to know that now is the time
to begin to make these changes. We can begin to work
together as a community, asking individuals to join in
together with us in order to face these issues, not just alone but together, core issues that we face
in our communities, such as chronic homelessness,
addiction and mental illness. For example, in the city of Everett, the city is partnering
with law enforcement, medical providers,
mental health providers, addiction treatment providers, low-income housing providers
and social service providers in order to create
comprehensive care plans to help with the chronic homeless
in our community, all of us bringing
our expertise to the table and developing holistic care plans, one by one, to help these communities
rise up off of the streets, get a place to live, get a job
and rejoin us as community members. If you know someone that could benefit
from an integrated care approach, would you suggest the resource? Because they do exist. The Everett clinic, for example,
provides behavioral health treatment to those to whom
they also provide medical care. And at Compass Health, we are beginning to more and more
provide medical care to those that come to us
for behavioral healthcare. We don’t have to stay stuck in a system that isolates us
from the care that we need. And we can imagine and we can envision what it would begin to look like
if integrated whole person care were widely practiced in our communities. People who are frozen in their situation having their suffering eased and regaining their lives
of emotional richness. Again, the homeless having
all the systems come together and approaching them
with a whole person care approach that really allows them
the best opportunity possible to get off the streets, get into treatment, get a place to live and begin that road of recovery
to a life that’s full of purpose. Parents who are ill and addicted
getting there suffering eased so that they can be the parents
that their children need them to be, to move beyond the hopelessness,
despair and anger and regain the confidence
and enthusiasm to raise their kids. I think this is our best shot at attacking the opioid crisis
both across the country and here at home. So many people with opioid addictions
have everything going on. They have medical challenges,
addiction challenges, mental health challenges,
basic need challenges. And unless we come together and bring forward an approach
that addresses all those needs, I don’t think we’re going to
make any progress in terms of helping them as individual or in attacking the problem as a whole. A friend of mine told me
about an experience that some have when they’re receiving treatment for AIDS. It’s called the Lazarus Effect. And in the treatment process, they move from being frail skeletons, and then they rise up out of that process,
the perfect pictures of health. I’ve seen this happen at Compass Health. People come to us and
they’re at the end of their rope. They don’t have a home, they’re ill, they have mental health challenges, they have addictions,
and they don’t have any hope. But when we’re able
to embrace them as a whole person, we give them that best opportunity to raise them up and have that experience to regain lives that are
full of recovery and purpose. And so, I ask that you’d join me in shaping and sharing a new future of health that treats the whole person and gives all of us the best opportunity to live lives that are full
of good health and happiness. Thank you. (Applause)

3 thoughts on “Integrated care: connecting medical and behavioral care | Tom Sebastian | TEDxSnoIsleLibraries

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