Seeking those who hesitate to seek us. One psychologist’s experience with integrated primary care


By Eric Lester, Ph.D.

What are common needs and psychological issues among older adults seen by a psychologist in integrated primary care settings? That is one question that I consistently asked myself while completing my doctoral internship at a community health center that was beginning to integrate behavioral health services with the primary care services; the two services had previously been co-located. It has been well-documented that many individuals who would benefit from mental health treatment are first seen by primary care physicians and their treatment may consist solely of prescription medications. Thus, a challenge for the health center and all care providers was to determine the best way to proceed, given the culture that had been established among employees and providers within the health center and the cultural expectations of the individuals who received medical and behavioral health care at the health center.

Our first step toward integrating the two services was to provide 10-minute, on-demand behavioral health consultations in a medical exam room. This was perhaps the most challenging part of developing an integrated service. The method of service delivery was far different from how most of us were trained. However, it allows patients, particularly those who would not otherwise seek our services, such as older adults, to have access to behavioral healthcare with less associated stigma. We received some referrals for traditional counseling from these brief consultations. However, for the most part, our contact with patients in the exam room was the only contact they had with a member of our behavioral health team until their next medical appointment.

Once the program was up and running, many patients with whom I worked were older adults. Patients were referred for a range of issues: chronic pain, diabetes management, depression, and diagnostic clarification. When appropriate, I asked patients if they would follow through with a referral to the behavioral health clinic. The most common reply was, “No thanks.” Yet, the older adults I saw in the primary care clinic seemed to be genuinely pleased that someone took an interest in them, spent additional time with them, and included them in the process of making decisions about their treatment. The interventions I commonly used ranged from psychoeducation about smoking cessation, to instruction on how to better manage anxiety, to motivational interviewing.

I completed my internship before data on the effectiveness of this first step of integration on patient satisfaction and self-reported well-being was compiled. Unfortunately, I do not have access to that information at the time of this writing. However, many of the physicians remarked that their patients seemed to be doing better after the center implemented the behavioral health consultations.

I believe that integrated care provides us, as counseling psychologists, with an opportunity to positively effect the older adults who might not otherwise seek or have easy access to mental healthcare services. Our focus on cultural competence, identifying and utilizing clients’ strengths, and advocating for social justice enable us to provide a voice for those patients who might not otherwise feel comfortable questioning their physician. We can help to improve their quality of life while helping them to gain better control over mental and/or behavioral issues.

About the Author:

Dr. Eric Lester is a guest blogger for the OA SIG.  He is a licensed psychologist working for the Chicago Christian Counseling Center where he is one of two licensed psychologists on staff. He received his Ph.D. from Ball State University and completed his internship at the Madison County Community Health Center. Eric also has a passion for teaching and has regularly taught undergraduate psychology courses at Elmhurst College and the College of DuPage.

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