Montana’s health care providers are well aware of the mental health crisis that’s ravaged the state for decades.
“We see patients every single day seeking mental health care,” Dr. Sarah Holexa, a Montana native and Missoula pediatrician.
Young people in her state take their own lives at twice the rate of their peers nationwide. However, rates of mental health diagnoses and treatment among young people remain low.
Recognizing that pediatric and primary care practices are entries into care for almost everyone, Holexa believed she and her colleagues could do more to screen patients for mental health needs and help them get services. But insufficient training, lack of time during appointments and limited referral resources stood in the way.
As a member of the Montana Chapter of American Academy of Pediatrics (MTAAP), she worked with the organization’s executive director, Kylee Bodley, to fund the evidence-based behavioral health training providers desperately needed.
“Behavioral health issues are not something you can treat with a short course of medication, like an ear infection.”
With support from Blue Cross and Blue Shield of Montana (BCBSMT), MTAAP is helping dozens of providers get trained to better recognize and assist young patients with possible behavioral health issues, including depression and anxiety.
“As a health plan, making this investment to improve physician success directly affects patient engagement,” says Dr. David Lechner, BCBSMT’s vice president of vice president of health care delivery and chief medical officer. “I’m really proud BCBSMT is a principal sponsor of this meaningful effort.”
Funding from BCBSMT and other contributors is helping provide training for up to 45 Montana pediatricians and primary care providers annually for three years. So far, about 40 medical professionals, including Holexa, have received training through the REACH Institute, a nonprofit that offers mental health courses for health care providers to help better treat and manage patients with behavioral health conditions. The group meets monthly to follow up and review cases, as well as provide feedback and encouragement.
“I feel so humbled to be able to have this opportunity to respond to a need,” says Holexa, who also is getting additional training in cognitive behavioral therapy. “I feel more equipped to fulfill my purpose.”
Commitment to expanding behavioral health resources
The past 10 years, suicide has been the second-leading cause of death for children and young people ages 10-24, according to the Montana Department of Public Health and Human Services’ annual suicide report.
BCBSMT has championed several initiatives to address the crisis. In 2018, it launched Big Blue Sky Initiative℠ to help fight opioid abuse, rising suicide rates and methamphetamine and heroin epidemics. The company also helped fund a new psychiatry residency to bring more mental health professionals to Montana, as well as other programs.
BCBSMT’s support for the behavioral health training program is part of its larger vision to create more medical and behavioral health access and better care management for members. Leaders believe more people could potentially be helped with primary care and behavioral health professionals working collaboratively to identify and help at-risk patients.
Research shows many people who die by suicide visit a doctor shortly before their deaths — some within 24 hours, according to the state report.
For example, headaches and chest pain described when patients seek medical care may be symptoms of a behavioral health issue rather than a physical condition. Lechner believes the training will enhance providers’ awareness of potential behavioral health struggles and empower them to screen patients more closely and help find resources more quickly.
“That’s an opportunity to tease out what could be a behavioral health diagnosis, but doing it delicately, to engage the patient and improve outcomes,” Lechner says.
Providers who have been trained say they already feel more confident and self-assured in these situations and less overwhelmed and stressed, Bodley says. “This is one thing we can do to help our providers feel supported,” she says.
Because of the training, young people in need of behavioral health services have about 40 more access points to care that could save their lives, Holexa says. The key to helping them is demonstrating dedication to their long-term care and well-being by building trust and rapport with them and their families.
“Behavioral health issues are not something you can treat with a short course of medication, like an ear infection,” she says. “These issues are unique and dynamic. Establishing a partnership with the family is really valuable.”
Besides feeling more equipped to evaluate patients, Holexa also feels better able to help supplement any advanced behavioral health care her patients receive.
“I want to help manage and be part of that treatment plan,” she says. “I want that handoff to ensure continuity of care is there. I wouldn’t be able to do that without this training. On behalf of myself and MTAAP, we thank Blue Cross Blue Shield of Montana for providing funding to the chapter so that myself and 40 other primary care providers across Montana can be part of the solution and increase access to quality mental health care.”