Tuesday, March 1, 2011
An earlier OPEN MINDS Circle post, Science Pushes Boundaries of Treatment in “Cognitive & Behavioral” Disorders, touched on a critical area in our health care delivery system. Our 65+ population needs comprehensive care for behavioral and cognitive disorders – but that need is not well served in our current system.
At Safe Harbor Behavioral Health, for example, it is not uncommon for our crisis team to be called to a skilled nursing care facility to evaluate a resident. While there is the occasional patient with a history of some psychiatric care, more often this situation presents as the patient’s first episode of “mental health” care. The patient’s clinical presentation is often complicated with significant co-morbid medical diagnoses (often with seven or more medications) and a range of cognitive issues. This is significant because the literature indicates that the incidence of medication-to-medication interaction increases significantly when patients are taking seven or more medications.
Our clinical team members are challenged to provide a comprehensive approach to the needs of this type of clinical presentation – an approach that includes an integrated evaluation looking at medical co-morbidity, medication interaction, and cognitive issues, as well as psychiatric diagnosis. In addition, the clinical evaluation is complicated by nursing home staff that are typically overworked, underpaid, and have little (if any) training in dealing with behavioral problems or de-escalation techniques.
To serve this population, a reframing of key issues and the development of a specialty assessment team is key. The assessment team needs to specialize in services for individuals over the age of 65 exhibiting signs of decomposition associated with the aging process, and the team approach should include an exhaustive evaluation with a thorough history, psychiatric evaluation, and neuro-psychological testing. Finally, the clinical team needs a format for integrating these findings and for communicating with family members or referring medical professionals.
For any provider organization with a future strategy that includes the 65+ population, now is the time to develop a thoughtful approach to the needs of the market. An approach that I think requires a “reframe” of the behavioral health system construct to be most effective – and most successful.
Jonathan D. Evans,
President & CEO, Safe Harbor Behavioral Health
& Advisory Board Member, OPEN MINDS
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