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Health Provider in Lewiston Innovates to Increase Access to Care
01/06/2014   Reported By: Patty B. Wight

Before the 1950s, people with severe mental illness in Maine typically lived much of their lives in psychiatric hospitals. But after the deinsitutionalization movement, those hospitals were downsized or closed. Maine's two state psychiatric hospitals went from a combined 3,000 beds down to the current level of just 140 or so. The idea was move those services outside the walls of the hospitals, and into the community. One community provider that employs an innovative approach to increase access to mental health care.

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Alyssa PelchatFor a businesses to be successful, it has to convenient to its customers. To that end, Lewiston-based Tri-County Mental Health Services has dozens of locations throughout Western Maine, and offers counseling and crisis services to 10,000 people a year. It reaches clients in clinics, schools, homes, and is now also placing social workers in a dozen primary care practices in the region.

"So my office is right here, and right next door is a shared wall with an exam room," said Alyssa Pelchat. She is the resident social worker at Central Maine Family Practice in Lewiston.

By joining a team of doctors, she said the hassles of the referral process are eliminated and patients with mental health problems can be seen quickly and avoid a possible crisis. "I've literally seen people 20 minutes after they call," Pelchat said. "Because they're having an anxiety attack, it's the first one they've had, they don't know what to do, and instead of driving to the ER, they're able to get into their doctor's office immediately to be seen."

Patient Angela Ricci wasn't sure what to do when she experienced disturbing thoughts during a flare up of her auto immune disease known as Crohns, which she said caused both physical pain and sometimes, depression.

"It was daily I would say death would be better than living with this disease," Ricci said. "Or when I would drive myself to the providers office, I would say,'I could easily just drive myself into this telephone pole right now, and it would all be over.' And this is not anything I've experienced before."

When Ricci alerted her primary care physician, the doctor first directed her to see a psychiatrist. But that entailed a four and a half month wait, and Ricci was ultimately referred to social worker Alyssa Pelchat. Ricci said she knew she need help but admits that the first meeting with Pelchat was difficult.

"The first words were, I don't think I need to be here. I think talking to you, frankly, is out of my comfort zone," Ricci said. "I think that if I need treatment for something, I can fix it."

But Ricci believes that having Pelchat physically present in her provider's office made it difficult to avoid her mental health. And Pelchat said that under this arrangement patients also get better medical care, because she and the physicians can easily communicate about a patient's specific needs.

"They can let me know, 'Ya know, this person is taking half the Zoloft they're supposed to be taking," said Pelchat." They don't want to switch to another medication, and I don't know what to do. And I can take the time to sit down [and say] let's talk about how Zoloft works. Let's talk about the fact you have other options."

This approach to outreach, say supporters, only confirms the strong connection between mental and physical health.

"I would say 70 percent of our visits in primary care have a psycho-social mental health component to them," said Claire Cote. She is Director of Care Integration at Central Maine Medical Center in Lewiston.

Cote said while the placement of Tri-County workers in doctors offices may represent a cultural shift, its an idea that offers real potential for patients with mental health needs.

"It's not necessarily an area that all of our primary care providers have been well trained in, or have had the resources," said Cote. "And so being able to have these resources right in their own practice to help their patients helps remove the stigma for patients to go to a mental health service."

The Meshing OF mental and physical health has had mixed results in the past. In a previous Tri-County program, physicians and social workers co-located, but record keeping systems were separate, creating a communication barrier. But supporters of this new iteration of the program say they believe its worked well. Patient Angela Ricci said her social worker focused first on Ricci's physical health issues to help her move past her reluctance to get mental health treatment.

"She was very good because she recognized that right away and said, Let's just shift the focus and talk about your illness and how you feel physically," Ricci said. "So that helped me open up to her."

Ricci said she no longer has morbid thoughts and now has the tools to help her avoid a future crisis because she had ready access to a social worker at her primary care doctor's office.

Photo by Patty Wight.


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