[Music] tegrated Behavioral Health Care is sometimes called Behavioral Health integration integrated care or collaborative care no matter what one calls it the goal is the same better care and health for the whole person i this episode of being well I'll sit down with Sarah Bush Lincoln's Dr ab out how ibh allows for better coordination and communication while working towards someone's mental health goals when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two hospital system with nearly 60 clinics that provide trusted Compassionate Care for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to ev er-changing needs of our community has remained the same Horizon Health 50 years strong Carl is redefining Health Care around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to Healthcare Carl with Health Al always at the Forefront to help you thrive [Music] thank you for joining us for this episode of being well I'm your La cey Spence and today we are we a new guest to the show from Sarah Bush Lincoln we've got Dr John Lauer joining us today welcome to being well it's my pleasure being here of course and since you're a new guest to the show we love to let our viewers get to know who they're they're learning from so if you could tell us a little bit yo urself well I'm uh father was a minister I met this Minister and I've been in th e Psychiatry now for over 30 years I was in Springfield for 11 years before I came to this area in 2003.

I ran the inpatient unit at Sarah Bush the psychiatric unit for 20 years and I've just started this new program with the integrated Behavioral Health this last year wonderful well and that is to pic today so we want to make sure everyone is informed and so let's start and open the floor by explaining what this is well right now in the United States there's a severe shortage of psychiatrists they think by 2025 there's goin about a thirty thousand psychiatrist shortage for the United States and in rural areas it's much more than that and so about 65 percent o physicians have nobody that they can refer to as far as psychiatric care um so there's a there's a real need in the primary care for Psychiatric Services integrated Behavioral Health is the practice of treating someone's mental health issues within the primary care office um so that they can get expert evaluations and get the same kind of care that they would get if they were going to a psychiatrist office most people feel most comfortable seeing their primary care provider and they don't a lot of people have are ve anxious about going to to a mental health office or a psychiatrist office a counselor's office but they feel very comfortable go their Primary Care office um also rig the psychiatric medicines used for depression and anxiety 80 percent of those are prescribed by Primary Care Providers right now and so they're already doing the majority of psychiatric Outpatient Treatment as far as pharmacotherapy medications but by doing this program they also get the advantage of having an expert in Psychiatry help them give those services to their patients so if I'm understanding right yo ur primary care doctor and they kind of learning the ropes or ge enough information from someone who's trained specifically for that to kind of walk them thro well um all Primary Care have some experience in Psychiatry during their training okay 25 of every patien primary care office comes in for a primary psychiatric reason whether it's they're depressed or not sleeping or lost their appetite those kind of things so they already have a very big population of patients that that have psychiatric issues coming in to see them what we're doing is I'm doing as sessments on the patients to find out what's going on and then I make tr eatment recommendations to the primary care doctor about what kind of therapy would be best for this patient what kind of medications if we recommend a medication what a dose of medication what the side effects are what we're looking for how we for those medications and yes wh doing integrated Behavioral Health I am teaching the primary care physicians more about Psychiatry so that they become more comfortable with it but also the patients getting the advantage of actually seei expert in that field so that they can feel comfortable they're getting same kind of treatment t a psychiatrist's office okay so they might not need to see you quite as frequently well the other thi Behavioral Health is that all the treatment is provided by the primary care providers I make recommendations the primary care providers write the medications or talk to the patients about the therapy they do all the follow-up and so if a patient has side effects or needs a different medication they go to their Primary and if needed then the primary care doctor will communicate with me back and forth about that patient's needs not very often do I see a patient for a second visit if a patient's having true problems I'll see them for a second visit but most of it is the visit is t figure out what's going on and then I can work through the primary care provider to give them the services t need and you we started that a lot of the patients you're seeing now virtually yes this is uh this is all virtual um professional she's a nurse that works with us Trevor Grimes and she this is a neat thing about integrated Behavioral Health is that if a patient pr imary care provider's office and they're having an acute issue say like they're having problems at their work or they're having problems with their spouse travel will show up on a immediately during that visit to do a psychiatric assessment to find out what their Chief complaint is what kind of symptoms they're having how acute it is what kind of treatment they have and then she will communicate with myself and we'll decide whether or not that patient just needs to be re to therapy needs a medication change or if they need to come and see me for a full evaluation my evaluations are also done all by Telehealth with the patients we see the patients right in their homes some patients like to be seen in their cars because it's a nice sound booth and it's also very secure they know that nobody else is listening in on them but patients feel much more comfortable talking to a psychiatrist in their own on their own turf than they do coming to the office and seeing us right I mean the the four white walls and a little bit intimidating I know I've been guilty of getting a little wh ite Coat Syndrome that's an excellent option so let's talk a little bit maybe ab some success stories walk through kind of how this might look like for a few different people and how you've been able to help for the last five providers at Sarah Bush have not been able to refer to the Outpatient Clinic and that's because they're just full they don't have they can't take pa tients so for five years a primary care doctors have had nobody to refer to but for the last year and a half since we've been doing this integrated Behavioral Health refer to us and now we have kind of opened up spaces so that when we see someone that really needs to see a psychiatric provider say their illness is severe then we can get them into t outpatient clinic now so now we're able to make referrals to the Outpatient Clinic where they couldn't do that before um we h um for example we had a nurse who had had problems with some obsessed-compulsive disorder for many many years never saw psychiat primary care provider was to the point where she was pretty muc I met with her for psychiatrists it was a st raightforward case but for a primary care physician who doesn't see this all the time it was more complicated a medication change and it's totally changed her life she went back to work she's no longer having symptoms do ing quite well so we've had a lot of successes like that where people couldn receive psychiatric care b receiving care and so these are people who coul possibly have been getting missed by the system because like he said these providers haven't been readily available and just kind of the stress on the the health system in general yes gotcha um so these initiatives you're talking about them coming up in the last couple of years I have to ask did t influence those at all um ther pandemic so it's a lot more acceptable accepted by patients and by insurance companies to do Telehealth now so that has made it a lot easier for us to give our services because of that um the nu experiencing serious mental illness has increased since the pandemic if you look at deaths of Despair and that's people that die from alcoholism overdoses or suicides in 2010 there was about 60 000 people per year who died secondary those causes during the pandemic it was a quarter million 250 000 people died from deaths of despair before the pandemic at any one time about one out of five people are dealing with the serious mental illness during the pandemic 40 percent of the American population expressed significant depression anxiety symptoms that they reported so that it went from uh 20 percent up to 40 percent so doubled during the pandemic and even now that we're coming out of the pandemic the rate is s three people experiencing serious mental health issues and so when you are all treating people what do you maybe notice is the most common um things that they' as they come into connecting pr ovider or connect with you um a lot of things that we see are people who have been thr with their primary care provider and been on several different medications or therapies and a much a very large amount of patients they actually have been misdiagnosed really and so by seeing a psychiatrist and you know we do this all the time and make the diagnosis that helps us direct the primary care providers to a more appropriate treatment Primary Care Providers are excellent at treating depression anxiety issues sometimes they just need some help just like you know I'm not an expert in hypertension and sometimes we need to see a cardiologist for that but so by making the more appropriat diagnosis that helps kind of helps with guide us about what kind of therapies they should have what kind of medications they have and outcomes after that the patients A lot of times they they are frustrated because why am I not getting be know most people get better why am I not getting better but just seeing un derstanding their issues and kind of educating them about what's goin lot of times just gives them relief knowing that oh that's w something else so if I'm somebody at home w watching and kind of like you said why am I not getting better kind of having those feelings at what poi need to do I seek out this program or does my primary recommend it to me how does that kind of come about you talked with your primary care provider we onl take referrals from Sarah Bush Lincoln's Primary Care Providers sure and um you if I was a patient I would go to my primary care provider and say hey I've been having this issue for quite a while it doesn't seem like what do ing is really helping do you I've heard about this in Behavioral Health do you think that would be appropriate your primary care provider could eith do one of those assessments during tha visit or we could set you up for a evaluation virtually with myself for a full psychiatric evaluation one other thing that we have available is some people do not want to see a psychiatric provider they do not want to see a psychiatrist they do not want t see a psychiatric nurse and so we have available the opportunity to look back at 20 years of history on the patients and their records summarize what kind of symptoms they've had what kind of treatments they've h recommendations to the primary ca provider saying hey this worke ago it may work now or she's already been on all these different things why don't we try this and that also ha very helpful for those patients who really don't want to see a psychi provider say hopefully you're personally I'm sure some can read minds but not really so um I have to ask this seems like more of a kind of a stepping stone of care but are there ever instances where folks maybe do have to become inpatient at the hospital Yes actually there's been a co where I've seen patients there was one patient from the pandem who had some issues before the pandemic with the isolation from the pandemic and she also had contamination fears she had obsessed-compulsive disorder she was totally paralyzed to the point where she couldn't leave her house and she actually she was to the point where she relied on everyone else to do everything for her because of integrated Be Health and because we could see her in her home I was able to assess her and re commendations so that she did go into the hospital and now she's doing better than she has in many many years but the pandemic for people that had contamination fears like obsessed-compulsive disorder yeah t pandemic was just really bad for them sure any sort of a note to Folks at home you know if you're concerned about seeking treatment just know that it's there to help you and that it can be a huge burden lifted it's nothing to be ashamed about do you think there's still maybe a stigma that you have to ag ainst so people will seek co urse ther thing about psychiatric illness is t um when people ill say like they have schizophrenia or manic depressive illness in their manic um people lose they're having issues so a lot of these people that are having active illness there's nothing wrong they don't feel that there's anything wrong th ey don't seek treatmen around them sees that there's a bu t they don't so that's one issu people don't seek treatment one issue is that people would have to wait it's not uncommon if you're referred to a psychiatrist and you can get in to w five to six months if you hear that you're going to hav wait five to six months you're prob not going to go to that appointment so that's um that going to be a stigma associated me ntal illness because people use denial quite well and they uh you know even though they would benefit very much and there's still a lot of stories about what psychiatrists used to do and what what Psychiatry entails and it's an unknown for people and they don't always feel comfortable talking about those issues or seeking out help for that since you have the floor are there any misconceptions that you might want to maybe try to iron out folks know well the main thing about psychiatry psychiatry is a branch of medi a medical doctor I went to medical school Psychiatry is a bra medicine that this that studies disorders of emotions emotions come from the brain and so it is a neural disorder psychiatric disorders just as much as having a seizure or having a stroke or anything like that so it is a physical illness that's affecting the brain it is affected by outside influences such as trauma that people can have other medical issues can affect their emotions but this is something that happens and it happens during someone's lifetime they have a 50 chance of having a major mental illness wow that includes phobias which are very common but even in women women have one out of three chance that sometimes during their life of experiencing major depressive disorder so it's much more common than it is rare and it is a physical illness that just affects our emotions in the way that we react rather than causing a seizure or causing paralysis like a other neurological disorders would and I think you bring up a great point to talking about how it impacts women more this season we're also talking about postpartum depression we're talking about post-traumatic stress disorder and trying to bring these conditions to light so peop understand them can maybe have opportunity to recognize them so know when to seek treatment so I have to ask do you only treat adults is there this service potential for children as well what does it look like I'm a uh I'm board certified in both adults and geriatrics um during our residency training we do have some child psychiatry but I only feel comfortable seeing people to the age of 16. we do have a child psychiatrist Dr hexel at Sarah Bush Lincoln who does see outpatients and her practice is currently open she also has a new mid-level that's working with her so there is the availability for pediatricians to have their patients see a child psychiatrist it's the adult patients that have absolutely no other option because they the primary care providers have known that they can refer to and that's what the area where concentrating on now there any trends that you maybe notice age related or not gender related or not that you are helping to treat well um one of the trends that we're seeing more and more of is increased substance abuse alcoholism we don't treat those in the so th e integrated Behavioral Health but we do assessments and we try to make those connections in the community so that those people can get care Psychiatry and Behavioral Health Services are all in silos like you have your medical care here psychiatric care here social worker or counseling here and then your substance abuse and a lot of times those silos do not talk to one another and so part of integrated Behavioral Health is to help break down those walls so that we can get people into where they need to be substa abuse issues it's it's very hard to get people into the right program sometimes and so by us doing the assessment and kind of directing them people are more able to get help so we've covered a lot here is an ything that I might have missed that you think would be important to pe ople well I think know that this is a program to help Primary Care Providers and their patients receive their mental health care in the primary care practice so that they don't have to go somewhere else to get their care so um this pro help the primary care provider what they already provide and really the pati don't have to go to a psychiatric facility or office to see someone so that it's a lot more intimate and they can keep it between them and their primary care provider and I'm ho w much you can speak to this so feel free to pass but as far as yo u know if insurance covers this type of treatment um insura an assessment when Trevor does an assessment they do not cover when we do a chart review they do not cover when a physician calls me for advice or we talk back and forth about a patient but they do cover my evaluations of pati when I see a patient do an evaluation they do cover that but there is absolutely no charge to a patient no charge for an asses that doctor to talk to me that is a program that Sarah Bush Lincoln is covering at this time sure and so the only charge in the whole this program is the evaluation by myself and that is covered by most insurance companies and Medicaid and Medicare out um uh not really I think that's I th that's the main uh main parts of it no worries at all so um Dr John Lauer thank you so much for being here today we've learned a lot about integrated Behavioral Health is looking for more information I'm sure you can connect with Sarah Bush's website connect with your ph ysician and they can definitely get you hooked up to the right resources and this is for only Sarah Bush patients a this time yes not at this time exclusively wanted to make sure that I ironed that out as well thanks again for being here today I appreciate it thank you my pleasure of course and ou r viewers for joining us for this episode of being well and I ho you next time Carl is redefining Healthcare around you innovating new Solutions and offering all levels of care when and where you need it investing in technology and research to optimize Healthcare Ca with Health Alliance is always at the Forefront to help you thrive for over 50 years Horizon Health has been keeping you and your family healthy and although some things have changed Horizon Health's commitment to ev er-changing needs of our community has remained the same Horizon Health 50 years strong when Sarah Bush Lincoln opened in 1977 it was with the promise to serve the community's health care needs it has grown into a two-hospital system with nearly 60 clinics that provide trusted Compassionate Care [Music] foreign [Music]