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Cynthia Ann Telles, Ph.D.

UCLA School of Medicine, Department of Psychiatry

Care through Integration: How primary care physicians may be the next step in expanding mental health care in under served communities

September 15, 2015 | Integration | Trauma | Comments
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It’s an unfortunate statistic, but more than half of all U.S. residents have experienced a traumatic event, including domestic abuse, sexual assault, neglect, or a natural disaster.  For families and individuals who live in communities that are racially and ethnically diverse, or that are low-income or under served, these events are more familiar than they should be.

This presents an ever-mounting challenge to providing mental health care in those under served communities. The dilemma remains: While people who live in these communities often experience the most traumatic circumstances, they often have the fewest choices for specialty mental health care. Many also face an even more fundamental obstacle: They simply don’t know where to find such care. While this presents a great challenge for health care professionals, it also identifies an opportunity for change and growth.

It has been shown that trauma can affect an individual’s health in a variety of ways, contributing to chronic illness such as cardiovascular disease, obesity, musculoskeletal pain, hypertension, depression and addiction. It’s a problem that should be and can be addressed.

Integrating elements of mental health care into primary care is a natural place to start. We know that most people will reach out to primary care physicians before they seek a mental health professional, if only because they are easier to find, and also because they often have existing relationships with those physicians and have developed trust in the care they receive. In communities where many are faced with acute traumatic events or longstanding traumatic conditions, “trauma-informed” primary care allows us to meet people where they are, and in places that are already more familiar and accessible to them — a community doctor’s office or clinic. Educating and empowering primary-care physicians to identify and help ease patients’ trauma can be a great leap forward in community health.

It’s important to recognize that primary-care physicians already have a heavy workload, making it difficult to take on another element of care. However, there is a clear unmet need and an opportunity to raise awareness of medical conditions caused by trauma — including hypertension and reduced immune response to disease — and make sure primary-care doctors know how to direct patients who have experienced trauma to the mental health support and resources they need.

This is why Kaiser Permanente remains committed to improving the total health of the communities it serves by partnering with safety-net organizations and helping make them part of the front line of trauma care. The Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation has pledged to help provide an opportunity for 14 safety-net organizations across the United States to join a yearlong educational effort. The learning programs build awareness of medical conditions caused by trauma, empowering these organizations to identify this type of issue in the patients they see. The National Council on Behavioral Health pioneers the educational program with the goal of making the safety-net organizations and community health centers “trauma-informed practices” and models for others to follow.

The need for this integrated approach to care underscores the importance of these safety-net partners who provide entry-level access to mental health care for hard-to-reach patients. If primary-care physicians can provide these patients with a choice of resources, referrals and information, we’re taking a step in the right direction. Success is reflected in education, awareness and communication, ensuring that our communities receive a more comprehensive form of care.

Together, we can make a difference in the lives of others, in creating healthier communities and, ultimately, in strengthening the fabric of society for the health and well-being of all.

To learn more about Cynthia Telles, you can follow her on Twitter here.