New Approaches in Behavioral Health

Behavioral health is a flexible term that can refer to a potentially broad set of medical issues. It is most often used when discussing mental health conditions like major depressive disorder, but, with growing frequency, it also applies to the diagnosis and treatment of virtually any behavior-influenced condition. These include chronic diseases such as diabetes, hepatitis, hypertension and obesity.

By understanding behavioral health as something that encompasses both mental and physical issues, health care providers – along with insurers and patients – may benefit from the design and implementation of more synergistic treatments. For example, a 2010 article published in the medical journal “Schizophrenia Research” found evidence that individuals with schizophrenia were much likelier to have hyperglycemia than the general population. Type 2 diabetes was also identified as a leading cause of illness and death among individuals with schizophrenia. In light of this evidence, a modern approach to behavioral health for schizophrenia might initially blend counseling with medications and lifestyle changes to produce more positive outcomes. At the same time, it could also include recommendations for preventing the onset of diabetes.

What are the Current and Historical Frameworks for Behavioral Health Practices?

There have been several watershed moments in the development of behavioral health, with some of the most prominent being the development of psychotherapy and the introduction of medications such as chlorpromazine, both in the 20th century. These developments revolutionized care for schizophrenia, depression and related conditions. More recently, there has been:

• Growing acceptance of the overlap of behavioral health with preventive care practices, pain management strategies and workplace wellness initiatives.
• Development of new approaches in the field, such as cognitive behavioral therapy, that address these intersections by accounting for both mental and physical health.
• Regular screening for substance abuse and mood disorders, which are often interrelated and as such may be best treated in tandem.

Overall, the current frameworks for behavioral health incorporate the field’s history in psychology and psychiatry, along with a newer focus on how behavioral interventions can also be beneficial for a wider range of conditions. The spread of behavioral health into primary care and into the treatment of pain are prime examples of how it continues to evolve.

Integration with Primary Care

Primary care clinics are frequently the gateways into the healthcare system for patients needing behavioral health assessments and treatments. As such, they are ideal sites for integrating key behavioral health services, such as interventions or consultations with psychologists to help with quitting smoking, changing diet or managing chronic conditions.

There are significant material benefits to such an approach. For starters, by making behavioral health more readily available to primary care patients, healthcare providers remove the stigma sometimes associated with seeking help on one’s own. In this way, they increase the chances that someone with a serious condition gets appropriate, timely attention. Long waits, rescheduling, and other logistical issues can be avoided altogether.

Moreover, a tightly integrated behavioral health program can reduce costs for both patients and providers. According to The Commonwealth Fund, one provider in Knoxville saw a 28 percent decline in utilization of medical services among Medicaid patients who had seen behavior health consultants for help with the self-management of non-behavioral health conditions. Meanwhile, commercially insured patients saw a 20 percent drop, and admissions of all patients to psychiatric hospitals by this provider was the lowest among all community health centers in Tennessee.

Cognitive Behavioral Therapy for Pain Management

Chronic pain management is a natural candidate for innovative treatments, since pain itself affects such a large segment of the population. The National Institutes of Health has estimated that it is the most common reason Americans access the healthcare system, and that it afflicts more patients than cancer, diabetes and heart disease combined.

Medical professionals have long understood – going back even as far as ancient Greece and Rome – the relationship between mental health and the perception and management of pain. This knowledge has resulted in the development of behavioral health practices such as cognitive behavioral therapy for pain management (CBT-CP), a technique the U.S. Veterans Administration has promoted in recent years.

Under CBT-CP, a patient might undertake relaxation training, cognitive restructuring and light exercise in order to help with the treatment of a migraine or arthritis. Combined with pain relief medications and other measures, these behavioral health practices may improve the overall quality of care for such chronic pain conditions.

Discovering and Supporting New Approaches in Behavioral Health

Thorough research and trusted professional guidance are essential as healthcare providers look for the most effective behavioral health treatments. To that end, utilization review and peer review can ensure providers are providing care based on current and emerging guidelines for behavioral health practices.

At Advanced Medical Reviews (AMR), an independent review organization (IRO), peer review in behavioral health can cover everything from appropriate utilization of prescription medication to reviewing the necessity of long-term inpatient care. Reviewers assess each patient’s case based on the specific history of symptoms and history of treatment for that patient, so outcomes can vary. And this variance is one of the challenges when measuring behavioral health treatment outcomes.

As behavioral health continues to evolve to cover more conditions and treatments, deeming what care is “appropriate” and “necessary” will also evolve. The ultimate goal, however, remains consistent, and is also what guides AMR’s services- “we believe every patient deserves quality healthcare.”

Sources:

http://www.commonwealthfund.org/publications/newsletters/quality-matters/2014/august-september/profiles
http://www.integration.samhsa.gov/integrated-care-models/behavioral-health-in-primary-care
https://www.thinglink.com/channel/622854013355819009/slideshow
http://www.integration.samhsa.gov/integrated-care-models/APA-APM-Dissemination-Integrated-Care-Report.pdf
http://www.southwestspineandpain.com/blog/southwest-spine-and-pain-center-introduces-behavioral-health-program
http://www.webmd.com/pain-management/features/cognitive-behavioral#1
https://report.nih.gov/nihfactsheets/ViewFactSheet.aspx?csid=57
https://www.va.gov/PAINMANAGEMENT/docs/CBT-CP_Therapist_Manual.pdf
https://store.samhsa.gov/shin/content/SMA13-4780/SMA13-4780.pdf