Struggling to recover from a stroke can lead to patients becoming depressed, or even face post-traumatic stress disorder.
Dealing with a chronic disease like coronary disease, heart failure, congenital heart disease, too, can result in patients battling depression.
Looking at patients holistically and recognizing how closely mental health is tied to caring for people’s hearts and brains has led the American College of Cardiology (ACC) and American Academy of Neurology (AAN) to join the BHI Collaborative, a group dedicated to catalyzing effective and sustainable integration of behavioral health care into physician practices.
The AMA established the BHI Collaborative with seven other leading physician organizations to help overcome persistent obstacles to integrating behavioral and mental health care into primary care practices and expand access to vital treatments for more patients. The collaborative now has 12 members after expanding to include a selection of non-primary care specialty associations who help manage longitudinal care for patients with chronic illnesses significantly affected by one or more comorbid mental health conditions.
In interviews featured on the “AMA STEPS Forward® Podcast,” ACC and AAN physician leaders spoke with Sea Chen, MD, the AMA’s physician director of practice sustainability. They explored why their organizations, representing cardiologists and neurologists respectively, decided to join the BHI Collaborative, what they see in their patient populations when it comes to behavioral health, and how they have seen success among practices that have integrated care.
Why cardiologists should collaborate
Cardiologists care for their patients over a continuum and patients face behavior health challenges throughout that voyage, said Indiana cardiologist Richard Kovacs, MD, chief medical officer for the ACC.
“We have cardiologists who are caring for adult congenital heart disease patients who have a lifelong journey of cardiovascular issues. We care for patients through acute illnesses like heart attacks who come out depressed. We care for patients with infective endocarditis who have substance use disorders. We have smokers,” he said. “We learned that every cardiologist has a little different view of this, but each one seems to have a consensus about the importance of this in the care of our patients.”
But cardiologists such as Dr. Kovacs find that they often have few tools at their disposal to assist with this part of their patients’ healing.
“The day before yesterday, I saw a post-infarction patient though, who was depressed. Yesterday I saw a patient needed bypass surgery; about a half an hour after he left the office, he called me and said how anxious he was now about an impending major surgery, reaching out for help. Which leads to a little bit of frustration on my part that for the depression and the anxiety, I didn't have the embedded solution. So, we're working toward that,” he said.
A solution in some practices is having a psychologist available that is truly embedded as part of the team, allowing the cardiologist to tell the patient another member of their team can help them with the feelings they are having and then do a warm handoff to the psychologist.
“It requires a lot of collaboration and team care. It requires having people readily available. It requires reinforcing that behavioral health is part of your cardiac care,” Dr. Kovacs said. “But when you have these components, you can be highly successful.”
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Neurologists recognize mental health
Neurologists see many patients with behavioral health disorders that are born out of the organic brain disease, said Boston neurologist and AAN president-elect Natalia Rost, MD, MPH.
Dr. Rost works with stroke patients.
“I often see depression in my middle age and older patients who are struggling in their recovery. Or anxiety or even post-traumatic stress disorder, like in those young stroke patients who have been traumatized by the stroke event itself and now struggle to regain their functionality as productive members of the society. They are often mothers and fathers to small children or main caretakers for their parents,” she said. “Obviously their organic brain disease due to stoke is affecting their behavioral health.”
Dr. Rost said neurologists need to be aware of their patient’s mental and behavioral health needs and “be proactive in seeking team-based solutions across the broad swath of issues where neurological and behavioral health overlap.”
The AAN’s Brain Health Initiative established an action plan that covers each stage of a person’s lifespan and created a new definition of brain health, which says that brain health is a continuous state of attaining and maintaining the optimal neurologic function that supports one’s physical, mental and social well-being through every stage of life.
“You can see we’ve organically incorporated mental well-being, ergo behavioral health, in our definition because they’re so tightly interwoven and that’s basically one of the strong foundations for our operation,” Dr. Rost said. “We understand that neurologists can't do it alone. I think we understand that the era of brain health for all requires broad collaboration between the multiple stakeholders, but on our end we're excited to join forces with the AMA in supporting their behavioral health initiative.”
Learn more
To help physicians offer mental and behavioral health services their practices, the BHI Collaborative has created an open-access educational webinar series.
The Behavioral Health Integration (BHI) Compendium, a one-stop online collection of resources from eight national physician organizations designed to help you on your integrated health care journey no matter where you are on the path, also is available.
