Bill could encourage ‘warm handoff’ for mental health treatment in CT

Jeff Walter looked into having the clinicians from his mental health and substance-abuse treatment agency partner with nearby primary care practices. He knew well that many people with mental illness don’t get primary care, and that many people who need mental health care don’t receive it.

But the arrangement Walter was hoping to set up wasn’t possible under the agency’s license, he learned. Instead, the agency, Rushford, would need a separate license for any off-site locations where its clinicians worked, even for one therapist to spend one afternoon a week at a primary care office.

“It just didn’t make any sense,” said Walter, who recently retired as CEO of Rushford and is now working for the agency’s parent company, Hartford HealthCare.

That roadblock helped fuel a push for legislation that passed the General Assembly earlier this month. It’s now awaiting action from Gov. Dannel P. Malloy.

It’s a somewhat technical measure — but one that Walter and others say could make it significantly easier for people to get treatment for mental health issues or substance abuse.

The bill would allow mental health or substance abuse treatment facilities to open satellite units or provider services at other locations without having to get a separate license. Each new location would still have to get approval from the state Department of Public Health.

“It would actually help people access behavioral health care in an easier, more streamlined and much more integrated way,” said Alyssa Goduti, vice president of business development and communications at Community Health Resources, which provides mental health and substance abuse treatment in eastern and central Connecticut.

A primary care doctor might suspect during a patient’s annual physical that he’s struggling with depression. If there was a therapist who worked out of the same office, Goduti said, the doctor could walk the patient down the hall and introduce him to the therapist, beginning their relationship there. Clinicians refer to it as a “warm handoff.”

Some health care facilities currently use them, including community health centers that provide both primary care and behavioral health services.

But because that sort of arrangement is rare in primary care practices, right now, it’s more likely that the doctor would simply give the patient a therapist’s card and leave it to the patient to call, Goduti said.

“The likelihood of the person actually going to get treatment is much less than if it’s that warm handoff and if it’s right then and there, if the person’s expressing the need for services,” she said. “It’s really, really important.”

The state Department of Public Health, which licenses health care facilities, supported the bill. The department is revising its regulations on mental health facilities, but doing so is a lengthy process.

Research indicates that many people who need treatment for mental health or substance abuse issues don’t get it — but many go to the doctor. And many health systems are trying to figure out how to better link primary care and mental health.

A Michigan health plan, Grand Valley Health Plan, redesigned its services in 2003, putting mental health counselors and nutritionists alongside primary care physicians and changing the name of the behavioral health staff to “health coaches.” Three years later, more than a quarter of members saw a counselor or nutritionist. More patients who needed mental health or substance abuse treatment got it at the primary care level, requiring fewer referrals to specialists. And the rate of mental health hospitalizations dropped by 54 percent, according to a 2008 article on the program.

Walter noted that patients already have relationships with their primary care doctors and feel comfortable in that setting, and that having a mental health clinician available could build on it. If patients instead had to get a referral, he said, it’s less likely that they would follow through and get the appointment.

“There’s stigma, there’s denial, there is inconvenience,” he said.

A spokesman for Malloy said the bill would be reviewed once it reaches the governor’s desk.

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