Physical And Behavioral Care Should Be Integrated

From mental health care to addiction treatment, TriHealth’s Behavioral Health Services team breaks down barriers to treat a subset of illnesses that affect about one in four adults.

Illustration by Katrin Rodegast

TriHealth of Cincinnati has launched a three-year initiative to embed behavioral health consultants in adult and pediatric primary care offices. Dallas Auvil, M.D., systems chief for Behavioral Health Services at TriHealth, says this effort to break down medical silos means better care for patients.

Behavioral health disorders are common and treatable.

Behavior-related illnesses like depression and substance abuse occur in about one out of four adults. And 15 to 20 percent of children suffer disorders such as anxiety and ADHD in a given year, Auvil says. Treatment options for these conditions are improving. “Older antidepressants were very difficult for people to tolerate,” Auvil says. “But those have advanced over the years. Also, the types of therapy that work are becoming more focused.”

Doctors need to address behavioral and physical conditions.

“The issue is we’re trying to treat the whole person,” Auvil says. “If a person has high blood pressure or heart disease, we care very much if they have depression. Are they able to take their medications? Are they able to get out and exercise like they need to? If they’re depressed, they can’t.” Quick treatment for the behavioral issues leads to better care for the physical ones, he says.

Utilizing a team approach helps doctors better understand patients.

Auvil cites the example of a TriHealth program that embedded substance abuse specialists in hospitals to treat patients who came in with drug overdoses. Patients going through withdrawal often become irritable and difficult. “Having someone there to say, ‘This is what this is and this is how we treat it sooner’—that really is a game changer.”

Primary care doctors treat the majority of behavioral conditions and prescribe three-fourths of the antidepressants, Auvil says. “But they don’t necessarily have the training to do that. They have heart and will. But they can’t do everything.”

Community attitudes are shifting.

“I’ve heard people say, ‘I don’t believe in psychiatrists,’ ” Auvil says. “They have the idea that they can pull themselves up by their bootstraps. I do believe some of that is changing. People are reaching out more for treatment. Now, we have to provide the access for treatment.”

Dallas Auvil, M.D., Systems Chief, TriHealth Behavioral Health Services

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