Offering Behavioral Health Services to Your Patients

With the rise of the opioid crisis, PTSD diagnoses among military personnel, the national teen suicide epidemic, and ever-increasing antidepressant prescription numbers, behavioral health professionals are finding their work discussed more often in newspapers and among politicians. This attention is raising the public’s consciousness on the topic and focusing the awareness of patients in need. For the behavioral health professionals reading this, I am sure you will agree. For those readers with other professional specialties, I urge you to continue reading this article as it is intended for you. The growing importance of behavioral health in the healthcare space means that there are a growing number of opportunities in a variety of medical specialties to utilize behavioral health professionals to better serve your patients and better support your practice.
Behavioral health is a broad term that refers most generally to the medical study, diagnosis, and treatment of patients’ emotions, behaviors, and biology as each relates to wellbeing. The term is often used interchangeably with mental health, but there are some (admittedly disputable) reasons why professionals in the field may tend to prefer the term behavioral health. So as to avoid wading too far into the debate, I will mention just two of many. First, mental health often arrives in the conversation with some stigma attached. Second, some find mental health too restrictive a term whereas behavioral health more readily includes the behaviors (e.g., abusing drugs) that link with mental conditions (e.g., addiction). There are likewise good arguments in favor of using the term mental health. Since I more commonly encounter “behavioral health” in my work for clients, I will use it here.
This article will focus on the two primary categories of behavioral health professionals—psychiatrists and psychologists—though I do recognize the invaluable role that licensed counselors, clinical social workers, psychiatric nurses, and others play in the care of behavioral health patients. Psychiatrists are licensed and trained physicians (MD or DO). Many reading this may draw the line between psychiatrists from psychologists at the former’s ability to prescribe medication. However, this is only the resulting ability that arises from particular training. Plus, as discussed in the next paragraph, that line does not hold in all states. Psychiatrists must complete at least eight years of education and training, including obtaining a relevant undergraduate degree, interning, and completing subsequent training to specialize in psychiatry. As with other physicians, the result is to equip the psychiatrist with the ability to use prescription medications, among many other tools, as part of patient care and treatment. In simplest terms, receiving the same general medical training as any other MD or DO puts psychiatrists in an optimal position to distinguish between primarily psychological disorders associated with physical symptoms and primarily physical disorders associated with psychological symptoms.
Psychologists hold doctoral degrees in philosophy (PhD) or education (EdD), each with a psychology focus, or in psychology itself (PsyD). While a psychologist’s training is different from that of a psychiatrist, it is not necessarily shorter. A psychologist will have completed an undergraduate degree, a master’s degree, a doctoral degree, and a multi-year clinical internship. Though they are not medical doctors, psychologists may provide psychotherapy and counseling as well as treat psychological disorders. As signaled in the previous paragraph, there are a few states (e.g., Illinois, Louisiana, New Mexico, among others) in which psychologists can obtain prescriptive authority in a manner similar to that offered in some states to certain nurse practitioners, but the vast majority of states offer psychologists no such option.
With that background in behavioral health professionals in place, I would like to discuss some examples of how physician practices can benefit from collaborating with a psychologist or psychiatrist. One of the more obvious collaborations is between behavioral health professionals and ObGyn practices. ObGyn physicians are responsible for their patients’ menstruation, contraception, pregnancy, childbirth, and menopause. Complications and concerns that may arise within those categories of care include trauma, infertility, pregnancy loss, postpartum depression, and birth defects, each of which represents an opportunity for the ObGyn to collaborate with a psychiatrist or psychologist to address resultant and/or associated psychological effects.[i]
There are many other examples of beneficial partnerships. Physicians who care for older patients may utilize behavioral health professionals in connection with the psychological and social effects of memory and sense deterioration. Physicians who handle workers’ compensation matters can coordinate with behavioral health professionals in connection with the determination and treatment of disabilities. Physicians who work in hospice and palliative care would undoubtedly serve their clients well by offering the services of a psychiatrist or psychologist during such a uniquely challenging time. Pediatricians can work with a behavioral health professional to better care for their minor patients (e.g., assisting in the diagnosis and treatment of ADHD). There may be psychological causes and effects of chronic pain and sleep difficulties that a psychiatrist or psychologist could pinpoint along with the primary physician. More generally, any treating physician could benefit from assistance with a patient’s failure to adhere to treatment regimens, which failure may have psychological causes. Either as primary or secondary care, integrating behavioral health services into a practice may be a good way to better serve patients.
While one may conclude from the foregoing that a physician should merely locate a number of local, reputable behavioral health practices to which they can refer their patients, there are advantages to bringing a behavioral health professional into the physician’s own practice. Paramount among those advantages is continuity of care. Working alongside a behavioral health professional in the same practice makes coordinating for consulting, observation, diagnosis, and treatment easier. Administratively, it gives the practice more control over availability/scheduling and access to patient records. From a financial perspective, the referring practice does not (and cannot) earn any revenue from referring the patient to a third party practice. If a practice’s patients would benefit from behavioral health services, then the practice can likewise benefit by making those services available “in-house.”
Depending on the restrictions in the applicable statutes and regulations, collaborating with a behavioral health professional may take any number of forms, from employment or contracting, for which a well-crafted contract can carefully define the terms of the collaboration, to co-ownership of a professional entity. Taking Pennsylvania’s ownership rules as an example, the regulations governing psychiatrists and psychologists both conditionally permit the formation of professional corporations with certain other licensed professionals. Specifically, the regulations of the Pennsylvania Board of Medicine, which governs psychiatrists, states that, “[a] medical doctor may form a professional corporation with other medical doctors or other health care practitioners who treat human ailments and conditions and who are licensed in this Commonwealth to provide health care services without receiving a referral or supervision from another health care practitioner, if the boards which regulate those practitioners also permit the formation.” The regulations governing psychologists take a broader approach, allowing them to, “professionally incorporate with other licensed psychologists or with licensed chiropractors, medical doctors, nurses, optometrists, doctors of osteopathy, pharmacists, podiatrists, veterinarians, dentists, engineers, nursing home administrators, physical therapists, occupational therapists, audiologists, speech-language pathologists, teachers of the hearing impaired and social workers, if the incorporation is also authorized by. . .” the regulations governing those professions. There are other restrictions that professionals must take into account (and Pennsylvania’s regulations often vary significantly from those of other states), but the example highlights that the possibility of co-ownership exists. We advise the reader to seek competent advice to ensure that what one is attempting to accomplish is doable and properly structured.
As noted at the outset, there is an increasing need for behavioral health services—a need that practices in other specialties may be able to do their part fulfilling. Importantly, Forbes and US News reported last year that the US is experiencing a shortage of behavioral health practitioners.[ii] Using data from the US Department of Health & Human Services, the Kaiser Foundation mapped the distribution of shortages in different states as of the end of 2018 (it is worth following the cited URL to determine where your area stands).[iii] Thus, if you think that your practice could benefit from a collaboration with a behavioral health professional, you may wish to take prompt steps to locate and recruit the right person. Contact us for more information about your options and opportunities.
[i] See, e.g., Poleshuck, Ellen L.,Woods, James, Psychologists partnering with obstetricians and gynecologists: Meeting the need for patient-centered models of women’s health care delivery, 69(4) American Psychologist 344-354 (May-Jun 2014).
[ii] See; Bruce Jasper, Psychiatrist Shortage Escalates As U.S. Mental Health Needs Grow, Forbes, February 25, 2018, https://www.forbes.com/sites/brucejapsen/2018/02/25/psychiatrist-shortage-escalates-as-u-s-mental-health-needs-grow/#37e0f2f01255; David Levine, What’s the Answer to the Shortage of Mental Health Care Providers?, U.S. News & World Report, May 25, 2018, https://health.usnews.com/health-care/patient-advice/articles/2018-05-25/whats-the-answer-to-the-shortage-of-mental-health-care-providers
[iii] Henry J. Kaiser Family Foundation, Mental Health Care Health Professional Shortage Areas (HPSAs), as of December 31, 2018, https://www.kff.org/other/state-indicator/mental-health-care-health-professional-shortage-areas-hpsas/
Andrew Stein is an associate at Lamb McErlane PC. He concentrates his practice in health law and business law. He represents individuals and businesses with a primary focus on licensed medical professionals, medical practices, and other health care entities. astein@lambmcerlane.com. 610-701-4433.