UW Health addresses mental health crisis with innovative clinic design

MADISON, Wis. – Humphrey is a behavioral health clinician at the UW Health Sun Prairie Clinic, a role new to UW Health primary care locations. Commonly considered specialty care, therapists typically see patients at a hospital or in a specialty clinic. And, due to demand, it can take months for a patient to meet with a mental health specialist after they first indicate they are interested in mental health support to their primary care provider.

Humphrey, who has a doctorate in psychology, is one of about 45 other mental health specialists who are part of an innovative program at UW Health designed to connect patients who need support for depression and anxiety with a specialist right at their primary care clinic.

The program is called Collaborative Care, and it is available for people 12 and older at all primary care clinics in Wisconsin.

Collaborative Care is a partnership between a primary care doctor and a behavioral health clinician embedded at each clinic, as well as a psychiatrist who is available to provide additional input. When a patient and a primary care provider determine that a patient has mild anxiety, depression or both, rather than giving a referral to UW Health Behavioral Health Services or a psychiatrist or psychologist at another location that could take weeks or months to see, the patient is introduced to the embedded specialist right there at their appointment.

“The doctor calls me in, and provides a ‘warm handoff,’” Humphrey said.

The specialist then meets with the patient to explain the program and to learn about their symptoms and, if needed, they set up a follow-up appointment for a couple of weeks later.

UW Health is meeting the access challenge head-on in two important ways, according to Shanda Wells, manager, behavioral health in primary care, UW Health.

First, it is faster and easier for patients. Patients are introduced to the program immediately, follow-up visits occur sooner, plus it is more convenient for patients to see specialists at their primary care location than to be referred to another location.

Second, because patients are cared for before their anxiety or depression symptoms worsen, it can prevent the need for more advanced care with a psychiatrist, psychologist or even an emergency department visit, potentially freeing up space in those settings for others in need.

“This truly benefits patients and the health system,” Wells said. “We can keep patients from reaching critical stages in their mental health by caring for them as soon as symptoms are realized.”

Wells, who has a doctorate in psychology, oversaw the program’s implementation, which started on a small scale in 2018 and began expanding in 2019.

“After the first year of use with adults, we’ve already seen the program’s impact,” she said. “Fewer patients are returning to our urgent care or emergency department who previously had gone to one of them for mental health needs after participating in Collaborative Care.”

Though the behavioral health clinician and primary care provider in the clinic are the most visible parts of the program, the new model has more behind the scenes, according to Dr. Mark Micek, medical director of population health, UW Health, and a primary care physician at UW Health E Terrace Dr Medical Center.

If a patient is in need of medication following their visit, the specialist or the primary care provider can prescribe it, but there is also a psychiatrist who supports each clinic and can offer recommendations for medication adjustments or additional therapies. Collaborative Care can provide care for up to six months. After that, if a patient does need more advanced or extended care, the behavioral health clinician can refer the patient to a psychiatrist or a long-term psychologist.

“This model is what its name says, it’s collaborative, not just for us as health care professionals, but also with the patient,” said Micek, who is also an associate clinical professor of medicine at the University of Wisconsin School of Medicine and Public Health. “The patient is at the center of all we do, and the level of care they would like, is truly up to them.”

There is one benefit of the program that stands above the rest, according to Humphrey, and that is trust.

Mental health is a very sensitive topic and patients often feel they can trust their primary care providers because of the relationship they build with them, she said.
This is especially true with people from historically underserved populations, Humphrey said.

“We hope this program will help those who may have been fearful of discussing their mental health feel safe and open to discuss their struggles before they get worse,” she said.