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April 10, 2023

Taking Care of the Whole Person by Integrating Behavioral Health with Primary Care

When you think of primary care, annual physicals, immunizations and visits when you’re feeling unwell may come to mind.

But how about help for conditions such as depression or anxiety, which affect an estimated one in five U.S. adults in any given year? We know that mental health directly impacts physical health, and vice versa.  Mental health conditions such as depression and anxiety can lead to insomnia, gastrointestinal problems and chronic pain[1], and can make illnesses such as asthma and arthritis worse[2,3]. Depression also stresses the immune system, and increases inflammation in the body[4,5] .

Or what if you or a family member is struggling with a substance use disorder related to alcohol or drug use?  These conditions can be obstacles to preventing and recovering from illness or injury.

Ultimately, your mind and your body are intricately related, together making the whole you.

In keeping with our commitment to taking care of the whole person, Avance Care offers expert behavioral health care for all ages that’s fully integrated with our full spectrum of primary care services.

Behavioral health is the prevention, diagnosis and treatment of mental health and substance use disorders. Services can include individual, group and family therapy, addiction counseling, and a range of other therapies. The goal of behavioral health care is to assist and support patients in making the changes needed to enable fulfilling, satisfying lives.

By integrating behavioral health experts within our primary care practices, Avance Care is helping to ensure that North Carolina residents know where to go for trusted, evidence-based treatment for mental health or substance use disorders ­– and are able to quickly access it.

Dr. Tad Clodfelter, vice president of Avance Psychiatry and Behavioral Health, shares more about how Avance Care’s behavioral health experts serve patients in need of assistance with conditions that include:

  • Depression and other mood disorders
  • Anxiety
  • Obsessive compulsive disorder (OCD)
  • Eating disorders, such as anorexia, bulimia and binge eating disorders
  • Personality disorders
  • ADHD
  • PTSD and trauma
  • Substance use disorders, including alcohol and drugs

How does Avance Care integrate behavioral health services with primary care?

We do that in several ways. We have behavioral therapists embedded in every primary care practice. They’re available for quick access and true integrated care.

We also offer behavioral care through the Avance Centers of Excellence in Psychiatry and Behavioral Health, which is staffed by more than 70 psychiatrists, therapists, and other mental health and substance use specialists.

Because we have so many different providers, we’re able to offer specialty care within Psychiatry and Behavioral Health as well. For example, let’s say you are seeing a therapist at your Avance Care primary care practice, but you need more specialized care in eating disorders. We have a team of eating disorders experts, including therapists and registered dietitians, available to help. You may see them at a primary care practice, or virtually, or at the Centers of Excellence.

Specific services provided by our behavioral health team include mental health screenings, comprehensive clinical assessments, neurobiological testing, and psychotherapy.

What’s the difference between psychiatry and behavioral health?

Psychiatry is led by physicians who specialize in mental health. It’s the medical side of mental health treatment, and includes medication management and other treatments for mental, emotional and behavioral disorders.

Behavioral health is led by licensed therapists, and focuses on the habits, thought processes and behaviors that impact a person’s mental ​and physical health.

Psychiatry and behavioral health are closely related. They’re both very important in helping people recover from substance use and mental health disorders, and there is a lot of collaboration between them.

What are some of the specialty areas that Avance Psychiatry and Behavioral Health have expertise in?

In addition to general psychiatry, we have medication assisted treatment (MAT) for substance use disorders. We offer care for treatment resistant depression (TRD), which is for individuals who have tried multiple medications for depression but who haven’t achieved long-term symptom relief. We have a medical pain service for folks who have pain disorder issues.

We have specialists in ADHD and trauma, including therapists who offer EMDR (eye movement desensitization and reprocessing). We have eating disorders specialists who also work with our nutrition team. We also have substance use disorder and addiction specialists. And we’re starting an adolescent program in 2023.

What are the most common reasons patients seek help for behavioral health concerns?

On the substance use side, we hear a whole lot about opioids and marijuana, and those are ubiquitous in our society. But still today, far and away, it’s alcohol – it causes the most problems and is the biggest killer. We see plenty of opioids, but we see more alcoholism. And post-COVID, alcohol use disorders are even more rampant.

On the mental health side, anxiety and depression are still far and away the most prevalent mental health disorders, and the severity of those has increased of late. Also with adolescents, it’s well documented what’s transpired for kids over the past several years is not a pretty picture, and we certainly see that presenting in our practices.

Do you need a referral from your primary care doctor to see a behavioral health specialist?

No, you don’t need a referral. We do get a lot of referrals from our primary care doctors, but you can also reach out to us directly. You can call to make an appointment with a psychiatry or behavioral health provider, whether you are an existing Avance patient or not.

How do patients benefit from the integration of behavioral healthcare with primary care?

At the end of the day, we are treating people. We’re not treating illnesses or diseases or disorders. People are whole beings. So it’s super important they are getting the annual well checks, and that they are physically healthy, and there are no medical concerns.

But you also want to make sure the mental health and wellness is there as well. Providing that integrated, collaborative care gets you the best result.

Our behavioral health experts may also be able to help with certain physical conditions, as far as helping patients adjust and adapt to them from a physiological and mental health standpoint – such as helping them with self-care and management of the condition.

For example, there is a high correlation between gastrointestinal issues, depression and anxiety. If you treat the anxiety and depression, the GI issues may resolve or markedly improve. That is whole person care.

How do primary care doctors work with Avance behavioral health specialists?

If a primary care doctor refers a patient to us, we’re going to be in contact with them about how that care is going, so it can be integrated into the overall care of the patient. The more information that each of the providers has, whether it’s primary care, psychiatry or behavioral health, the better care can be.

What are some challenges patients have in accessing mental health or substance use treatment, and how does Avance Care’s integrated model help overcome barriers to care?

There are huge access issues in the community at large, in the state and in the nation.  Fortunately, at Avance, we don’t have that issue. Another thing that makes us unique is we have a very short wait time. If you are an Avance patient, or if you want to get services from us even if you aren’t an Avance patient and you reach out to us directly, we can get you in for an appointment within three weeks, and usually much sooner than that.

What message do you have for patients who are struggling with alcoholism or drug use?

We tell all of our patients that there is a lot of hope. All of these disorders, in spite of how far down the tracks they may have gone, or how hopeless or helpless they feel, that there is hope. Each of these disorders in the substance use realm are treatable. People do recover, and they can recover, and we know it.

Is that usually through a combination of therapy and medication?

It’s usually a combination. If their condition is super severe, sometimes people need the safety of the four walls of a rehabilitation stint first. But most of the time, we can treat folks as outpatients. It’s through a combination of medicines on the psychiatry side, individual and group therapy on the behavioral health side, and oftentimes couples or family therapy as well.

What are the goals for patients in an integrated behavioral health-primary care practice?

The goal is overall wellness. That any physical or mental health issues are being cared for, such that the patient’s functionality is optimized. That’s done best when there is collaboration, communication and awareness.

Avance Care is here to treat and care for you as a whole person. If you think it’s time to start taking care of your mental and emotional health alongside your physical health, Avance Care is here for you.

If you are interested in learning more about our behavioral health services integrated at your primary care office, speak with your primary care provider today. They will be able to connect you with a therapist right at your office, virtually, or with a therapist at the Avance Centers of Excellence.

If you are interested in learning more about Avance Psychiatry, ask your primary care provider, or call 919.748.4878. Our team of psychiatrists and mental health professionals will coordinate with your primary care provider, so all of your healthcare journey is streamlined and collaborative.

To learn more about Avance Care Behavioral Health, visit here.

To learn more about Avance Psychiatry, visit here.



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