HSC News, Volume: XLIV, Issue: 22
With the assistance of a $5.3 million grant from Methodist Healthcare Ministries of South Texas Inc., The University of Texas Health Science Center at San Antonio is poised to become a pivotal partner in the delivery of mental health care services in San Antonio and South Texas.
The four-year grant, awarded Oct. 12, will fund the creation of the South Texas Access to Recovery Program (STAR). The program will begin in January and will establish a new, multidisciplinary training and clinical care program and address the acute shortage of access to behavioral health care and mental health professionals in the region.
The Department of Psychiatry in the School of Medicine will coordinate the grant in conjunction with the School of Nursing's psychiatric/mental health program and the Physician Assistant Studies program in the School of Health Professions.
"We are very grateful for this grant from Methodist Healthcare Ministries that will help us improve mental health care services for San Antonio and South Texas," said William L. Henrich, M.D., MACP, president of the UT Health Science Center San Antonio. Kevin C. Moriarty, president and CEO of Methodist Healthcare Ministries, said, "The demand for mental and behavioral health services is not likely to shrink the way state funding for services did during the last legislative session. There is a great need, especially in light of the many individuals and families who will be impacted by those state cuts. Our hope is that the funding we have committed to will ease some of the burden our communities will suffer as a result."
Shortage of mental health professionals
Pedro Delgado, M.D., professor and chair of the Department of Psychiatry at the Health Science Center explained, "The need for mental health care professionals in South Texas is immense. Texas has only about half the number of mental health providers per 100,000 residents compared to the national average, and one in 20 South Texans will develop severe mental illness at some time in their life. As our mental health providers get older and the population of our region increases, it is important that we create a pipeline of health care providers now and come up with new ways to provide care, especially for the most vulnerable patients who do not have access to care for a variety of reasons."
Some of the reasons for difficulty in accessing mental health care include the stigma associated with having mental illness, cultural inhibitions, lack of private health insurance, shortage of psychiatrists and limited number of coordinated mental health programs to treat individuals with multiple diagnoses, said A. Camis Milam, M.D., associate professor, chief medical officer and psychiatrist-in-chief in the Department of Psychiatry, who is co-principal investigator of the grant along with Dr. Delgado. "About 1,000 patients each month go to the Crisis Care Clinic and local emergency rooms for mental health care treatment," she said.
STAR will address these issues by:
- Creating four new behavioral health training and practice programs;
- Establishing a transitional care clinic to provide for the needs of patients who receive care from local emergency rooms and inpatient programs;
- Integrating behavioral health care into community care settings in a patient-centered model.
New education programs
Currently, very few mental health care professionals enter public health or health care systems to provide care for the underserved population in South Texas. To increase the number of professionals in this field, the Department of Psychiatry is creating a Community Behavioral Healthcare Track. Beginning in July, two psychiatry residents each year will be admitted to this new track within the four-year residency program. A new position will be established in the clinical psychology residency program in the Department of Psychiatry.
The grant also will enhance and expand the School of Nursing's Master's of Science in Nursing psychiatric/mental health nurse practitioner program in community behavioral health. Beginning Jan. 1, the grant will support a behavioral health nursing faculty member and provide scholarships for psychiatric/mental health nurse practitioner students. This community behavioral health collaborative project is expected to produce up to six graduates each year.
In addition, a special certification in behavioral health care will be developed with the Physician Assistant Studies program in the School of Health Professions with the grant supporting faculty time and two students per year.
As the program matures, plans are in place to add training for social workers and other health professionals through collaborations with existing programs at the UT Health Science Center, UT San Antonio, Our Lady of the Lake University, UT-Austin and other universities.
Transitional Care Center
The second key component of the program is the Department of Psychiatry's plan to open a new, specialized behavioral health care clinic called the Transitional Care Center (TCC) in 2012 in the University Plaza Building, near the Health Science Center.
At the TCC, an interprofessional team will provide evaluation, medication management, psychotherapy, rehabilitation services and case management using a best-practices team approach and an integrated behavioral health care setting. The clinic will be available to those referred from inpatient units and emergency departments throughout the county for up to 90 days and will accommodate up to 550 patient visits a month. This model also addresses those individuals who may be unable to comply with office-based care during an acute episode and have difficulty functioning in society.
"Our goal is to help patients recover from mental illness and to get the care they need on a continuing basis, rather than experiencing repeated crises and getting care through emergency rooms and hospitals," Dr. Milam said.
"This project will expand the pipeline of behavioral health experts who can provide care to those who are most vulnerable with the greatest need. They in turn will educate their medical and nursing colleagues to screen and refer more effectively on the front line in primary care, thus intervening earlier and preventing more serious illness." said Julie Novak, D.N.Sc., RN., M.A., CPNP, FAANP, associate dean for practice and engagement in the School of Nursing and a collaborator on the grant.
Patient-centered care model
The third key component in STAR is integrating behavioral health care into primary care settings in a patient-centered model. With specialized training in behavioral health, nurse practitioners and physician assistants, who are already familiar with working as part of the primary health care team, will become critical players in providing mental health care to patients with the help of telepsychiatry — a form of teleconferencing used to connect primary care providers, their patients and specialists in behavioral health care. The clinical model is designed to be easily adapted to a variety of settings, and practitioners who utilize the model will have ongoing support from the university as needed.
"We have to look for innovative ways to provide access to care, more and better qualified providers, treatment for patients in their own communities and cost efficiency," Dr. Delgado said.
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