By Jonathan Springston, Editor, Relias Media
Eight leading U.S. medical associations have formed the Behavioral Health Integration Collaborative to help physicians include mental and behavioral health services in everyday practice.
The all-encompassing online toolkit provides educational material and best practice information regarding behavioral and mental health services. The collaborative includes everything from how to build telehealth services into primary care to relevant billing and coding practices.
There is growing recognition of the importance of providing these services. Although physicians may be willing and eager to engage, a study released earlier this year revealed cultural, financial, and educational barriers to proper service integration.
As the COVID-19 pandemic drags on, the need for better mental and behavioral healthcare might only intensify. A tracking poll revealed 53% of Americans are feeling negative about their mental health. A CDC investigation indicated young people, ethnic and racial minorities, and essential workers are disproportionately affected.
Clinicians might see the need for mental and behavioral health interventions daily, whether in the form of an irate visitor looking for answers about a loved one receiving care or a waiting patient with undiagnosed psychiatric needs slowly spiraling in the waiting room. Unfortunately, as reported in the cover story of the upcoming November issue of Medical Ethics Advisor (MEA), too often the knee-jerk response might be a frantic call to hospital security personnel.
“The tendency is to look at it as a criminal matter, and that this is a bad person. But they are probably just a regular person who is demonstrating symptoms of a disease state,” Scott Zeller, MD, vice president of acute psychiatric medicine at Vituity in Emeryville, CA, tells MEA. “From an ethical standpoint, that is the one thing that always stands out to me. We don’t get angry at a person for having shortness of breath. We don’t yell at them for having chest pain.”
Police officers are not mental health professionals, but often are called to help a person in crisis. But calling in a swarm of security to subdue an angry patient sends a terrible message. The patient/physician relationship is based on trust, confidentiality, protection of patient autonomy, and the belief that clinicians will act in the best interest of their patients. “When law enforcement is called in, it can undermine these tenets of the clinician-patient relationship,” Keren Ladin, PhD, MSc, director of the for Research on Ethics, Aging, and Community Health (REACH) Lab at Tufts University in Medford, MA, explains to MEA.
The same is true if clinicians are constantly calling hospital security on patients. It raises concerns about whether providers are acting in patients’ best interests. The better approach, according to those interviewed for the article, is to pair security personnel with mental health professionals, counselors, and other from various disciplines working at a facility to de-escalate volatile situations. Developing a multidisciplinary team also means leaders must provide better training for staff and create proper procedures for handling irate patients.
Sadly, administrators might not lead proactively, waiting to change the culture only after a terrible outcome. Administrators may be reluctant to make a financial investment in training proactively. Ethicists can help clinicians make the case that it is a small investment for what could be enormous preventive savings. “It takes only one incident to get the hospital in all kinds of legal trouble, and ruin the hospital’s reputation,” Zeller says.
Zeller is the host of three Relias Media behavioral health-focused webinars, all of which are available here. Learn even more about psychiatric emergency care in Episode 7 of Relias Media’s “Rounds With Relias” podcast series.