LRU News

Choosing a new direction to fix U.S. healthcare – It’s time to treat the mind AND the body

Thu May 1 2014

HICKORY, N.C. — One of this nation’s most pernicious problems is dwindling returns from our healthcare dollars. American medical care is pricey and, when compared to the rest of the world, just not that good.

“The U.S. has the most expensive healthcare system in the world—it’s almost twice as expensive on a per capita basis as the second most expensive nation,” said LR’s professor of psychology Dr. Gordon Cappelletty. “But we’re No. 37 in terms of outcome. We’re paying for a Maserati and we’re getting a beat-up VW.”

One big problem is that those who have no healthcare wait until their medical problem becomes so severe that it can no longer be ignored. And that’s expensive. Another big problem is that our healthcare system is fragmented. We treat mental healthcare and physical healthcare like they’re stepsiblings.

“We know that people with mental health problems are the most expensive medical patients we have,” Cappelletty said. “Mental health problems, left unattended, become physical healthcare problems. Now there’s a movement to bring mental healthcare and physical healthcare together. They should coexist.”

Here’s an example of how stress can become a physical illness, according to Cappelletty:

A stressor causes the hippocampus to respond by excreting a chemical receptor known as CRF, which impacts the pituitary gland, and depresses the immune system while increasing cortisol and adrenaline. If the chemicals keep flowing they can cause high blood pressure, impaired kidney function and a decreased ability to resist infection among other problems like diabetes and heart disease.

And the first place patients with panic disorder go when their condition flares up is the emergency room—they’re convinced they’re having a heart attack. Days and thousands of dollars in tests later the patient will be diagnosed with an easily-treatable mental health condition. It’s a similar story with depression. The first stop for many who are depressed is their doctor’s office. They go because they’re having frequent headaches—a common symptom of depression. Many stop at the doctor’s office having addressed the symptom, but never go on to get the mental healthcare they need to solve the underlying problem.

The coexisting model has already been tried with significant success, in Europe, and it’s brought healthcare costs down significantly.

“France and Germany are doing this and their healthcare system costs them about half of what it costs us here,” Cappelletty said. “It’s estimated that one in every four or five people who come into a doctor’s office complaining about chronic health problems are also suffering from mental health problems—and many of them are never treated for the underlying cause of their health problems.”

One way Lenoir-Rhyne is working to address the potential benefits of healthcare integration is through the design of the school’s new physician assistant program.

“We anticipate student exposure to psychiatric conditions not only during their didactic – 1st year course work—but also in several core clinical rotations, which include; Family Medicine, Pediatrics, Emergency Medicine, Women’s Health, Behavioral Medicine and Internal Medicine,” said LR’s Chair of Physician Assistant Studies Program Helen Martin. “The PA program has obtained clinical affiliation agreements with several Psychiatric/Mental Health Facilities in the Hickory and Asheville area. These facilities will help educate physician assistant students who will help eliminate the shortage of healthcare providers.”

A fully-integrated mental health and physical health establishment would look like a typical doctor’s office except for the fact that the space is shared by mental health professionals who work in tandem with their fellow medical professionals.

“If you’ve got four or five doctors along with physician assistants and nurses they’d be working alongside two or three mental health counselors,” Cappelletty said. “They need to be there because if a doctor’s trying to get someone who’s dealing with depression or anxiety, or they’re borderline psychotic they’re not going to respond to a doctor’s orders nearly as well as a mentally healthy patient.

He’d like to address the problem here in his own backyard. He wants to follow the integrated model that’s proven successful at East Tennessee University.

“We’re much better than we were 30 years ago,” Cappelletty said. “In general people are much more willing to see a counselor. Some are still leery of psychiatrists, less so of psychologists. They’re much more open to seeing a ‘counselor.’”

Today there’s a major roadblock to mental and physical healthcare integration in North Carolina: funding.

“Right now under state DHHS regulations Medicaid won’t pay for mental healthcare that’s provided in a doctor’s office,” Cappelletty said. “Until the regulations are changed it will be impossible for healthcare professionals to adopt a truly integrated model, but we are working to change that.”

Medical and mental health professionals have the same goal: They want to care for their patients.

Information sessions on LR’s new Physician Assistant program will be held on May 17 and June 7 from 9 – 10 a.m. in the McCrorie Center room 213. During the session details will be given on the Bachelor of Science in Medical Studies (3+2 program), which allows students to graduate in five years with both an undergrad and graduate level degree. To register for the sessions visit LR.edu/PAsession.

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