Integrating Mental Health With Primary Care at a Nurse-Managed Health Center
Exclusive Interview: Philadelphia’s Family Practice and Counseling Network (FPCN) founder Donna L Torrisi, MSN, CRNP
Each year, over a quarter of the adult American population develops or continues to suffer from some type of mental illness, according to the National Institute of Mental Health. Poor mental health can affect an individual's quality of life and their ability to function on a basic level. Yet many Americans do not have access to mental health care because they cannot afford treatment or don't have transport to facilities. Those who do have access sometimes choose to avoid treatment because of a perceived stigma associated with being mentally ill. Uninsured and low-income patients--whose need is often the greatest--typically have the most difficulty in accessing mental health care.
At Family Practice and Counseling Network (FPCN), the integration of behavioral health services with primary care eliminates red tape and gives patients instant access. "It is an incredible service," says Donna Torrisi. "The patient does not need to be put on a waiting list or given an appointment."
As the first-ever nurse-managed Federally Qualified Health Center, FPCN has been providing public housing residents with primary care and behavioral health care for nearly 18 years. Until recently, the services were managed and administrated separately. Torrisi says, "Because we served a low-income population who were vulnerable and at-risk, primary care would refer lots of people over to behavioral health who were anxious or depressed or who had PTSD or substance abuse or were going through failing marriages."
After being referred, patients would have to make an appointment to see a behavioral health care provider. The responsibility then lay with the patient to keep the appointment and juggle the related tasks: taking time off work, finding child care, finding transportation, and of course fielding questions from friends and family about why they had to return to the center. Or they might be on a waiting list for so long that their issue had escalated by the time they finally saw someone.
This approach is the conventional one, but it doesn't fulfil patients' immediate needs. "Our behavioral health department could only absorb so much, so there was always a waiting list," Torrisi explains. "Our patients were frustrated, our primary care providers were frustrated, and as a result our behavioral health providers were frustrated, because they knew we were a little bit annoyed that they couldn't take our patients!"
The lack of an efficient process for providing patients with behavioral health care placed an additional burden on primary care providers at FPCN. "We can't get them into behavioral health and we get bogged down trying to do the counseling," Torrisi says. "We have a patient in there who's sobbing, a patient in the next room waiting for us....it's very hard just to walk out on them. You want to help people put the pieces together."
Then a novel idea emerged. "We got hold of this idea of integrating a therapist into primary care, and we thought, oh, we'd better try that," says Torrisi. "So we hired a licensed clinical social worker in each of our offices, to be embedded in primary care."
This integrated approach gets the patient the care they need immediately. At the primary care provider's request, the social worker comes into the exam room and acts as a consultant. Together, the social worker and the primary care provider--who is usually a nurse practitioner --create an assessment and treatment plan for the patient. If necessary, the social worker offers guidance on whether the patient should be referred to long-term care or put on medication.
With the new system, many of the obstacles to patients receiving mental health care have been eliminated. "They don't have to go somewhere else, get carfare, get child care, and endure the stigma of going to behavioral health," says Torrisi. And since FPCN is a Federally Qualified Health Center, the center's funding remained untouched by budget cuts to mental health programs, so patients can afford the treatments they need. Lastly, the integrated approach cuts down on paperwork and administrative time for the center, allowing nurses and other staff to focus on providing direct care.
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