Passionately and Persistently Working to Integrate Mental and Physical Health By: L. Read Sulik, MD, FAAP, DFAACAP

The national dialogue about mental illness and what needs to change about mental health care is refreshing . . . as it is, each and every time that the nation is triggered to wake up and pay attention for a brief few moment.  Patrick Kennedy was on 60 Minutes last Sunday to spur this conversation more, discussing Integration of Physical and Mental Health Care.  He has been trying for some time now to do his part to wake us up and pay attention.  This week is our country’s Mental Illness Awareness Week (MIAW, October 5th-11th), which also encompasses this Saturday’s World Mental Health Day (WMHD, October 10th) and we will as a result pay attention. . . for a brief few moments. Every time the country experiences a tragic school or community shooting, the discussion turns again to the need for mental health care, for a brief few moments.  After these moments of immersion in awareness and this period of striving to understand what and how we can change what we do and do not do,  the nation  and even the world quickly “recovers” and moves on to its preconditioned state of usual.

The unfortunate, harsh and brutal truth is that mental illness is not brief, and simply “moving on” does not lead to returning to a previous state.  So what if as a nation, we did not just briefly talk once again about the seriousness of mental illness and the need to change, but what if we could truly embrace and harness the gifts of sensitivity, intensity and passionate persistence to truly imagine thriving.  I can say that I am now passionately and persistently imagining thriving since joining PrairieCare one year ago as Chief Integration Officer, charged with bringing teams of mental health clinicians (Licensed Clinical Social Workers and other licensed mental health therapists, psychologists and psychiatrists) into the primary care and specialty care clinic settings.  This is an area I have spent much of my career to date trying to do in one way or another. Having trained in an integrated residency program, called the Triple Board Program, in Pediatrics, Adult Psychiatry and Child and Adolescent Psychiatry the idea of bringing these worlds together seemed so natural and obvious to me coming out of training that I accidentally started to do “integrated care” when I started my career in St. Cloud at St. Cloud Hospital in 1999.  In the past, I haven’t always had the tools or skills needed in “change management” to truly lead these efforts through a process of sustainable change that prevents the drive to “move on to the preconditioned state of usual”.

Changing the way we think and talk about mental health and changing the way we provide mental health care requires the realization that these are complex challenges.  We cannot fall back into repeatedly applying quick fixes. Here is what I teach my patients:  In order to undergo the required passionate persistence needed for sustainable change, we have to develop insight into the problem and the need for the change; we must have intention to undergo the change needed; we must have the supportive structure to undergo the change within; and we must persistently practice the new rituals in thinking and in how we do things in order to keep us from “moving on back to our preconditioned state of usual”.

In April we founded the PrairieCare Institute and our tag line is “Nurturing Creative Innovation in Health and Wellbeing” which came from the questions we finally asked ourselves.  “What if we actually nurtured creativity and innovation in thinking about and providing care differently and what if this actually could lead to significant change in how we think about mental health and in how we provide mental health care?”  The PrairieCare Institute is our design, innovation, research, training, and community resource center where among other things, our work on integrating primary care and mental health care together will be driven.

We are now creating a “clinic within a clinic” and will be bringing teams of mental health experts to collaborate together with the primary care or specialty care team in their clinic to serve and care for their patients in a different and more effective way, together.  Through screening, consultation, comprehensive assessments, brief psychotherapeutic interventions, access to health psychology and to psychiatry in the clinic directly or through telehealth suites we will improve access to mental health care for those individuals who may never obtain access to care in any other way. This “clinic within a clinic” model allows us to operate as PrairieCare and bill for our services independently of the primary care clinic and frees the primary care clinic from the financial burden of building up their own mental health services.

I stepped into a Caribou Breuggers in Maple Grove on Bass Lake Road one day and realized “they did it”, they have integrated two businesses and co-branded them collaboratively, creating a new experience for their customers. They used to be “adjacent” and then became somewhat “co-located” and then a space was opened between their adjacent restaurants and that made the “collaborative” somewhat.  This restaurant was different.   I was intrigued.  I saw the opportunity to learn from others outside of healthcare how to be effectively collaborative and integrated. I sought out one of the leaders of this at Caribou, Michael Heller, and I went and met with him at the Caribou headquarters.  In our discussion about how they had successfully brought these two different businesses together he stressed the importance of the “customer experience” and preparing them effectively for the change.  I thought immediately of why we push to integrate care.  Over 50% of patients identified in a primary care setting as having a mental health need and then referred to a mental health provider, somewhere, will not be able to follow through with that referral.  The illness in and of itself creates debilitating barriers that impede the ability to navigate through the referral process and even just “show up”.   Bringing primary care and mental health care together is in a way like integrating food and beverage together effectively.  Imagine going to a restaurant and ordering your food but having to go to another restaurant and ordering your beverage but never being able to have your food and beverage together.

I am pleased to announce that we will be opening our first phase of Clinic within a Clinic this November with our first two creative and innovative pediatric partners:  South Lake Pediatrics and Wayzata Children’s.  Over time we will demonstrate that there is a way to nurture creative innovation in health and wellbeing and change the way we think about health and change the way we ultimately deliver care collaboratively together.

So stay tuned as we continue to challenge ourselves and our partners to harness and embrace our own sensitivity, intensity and passionate persistence to make a sustainable difference that can matter so that all of us may one day “imagine thriving”.



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