Along with physical illnesses, the COVID-19 pandemic has exposed major mental and behavioral health challenges, and thankfully, help is now available at many UCHealth primary care clinics.

In a recent national survey, nearly one-third of respondents said they were suffering from anxiety or depression, according to researchers at the Centers for Disease Control and Prevention and the National Center for Health Statistics.

Kristin Orlowski has a doctorate in psychology and practices at UCHealth Family Medicine in Littleton. Every day, she is seeing the turmoil that COVID-19 is causing.

“The pandemic is exacerbating issues that were there before and also seems to be triggering the onset of new symptoms in some patients,” Orlowski said.

“People with obsessive compulsive disorder, for example, may already have been obsessive about germs and handwashing, but now, some people are having a hard time leaving their home without feeling panicked.”

While the suffering is hard on patients, Orlowski is grateful that more people are seeking help and that she can offer integrated behavioral health care right in the comfort of a primary care clinic.

“It’s such a great benefit, not only for the patient, but also for the provider,” Orlowski said.

Behavioral health integration

In other settings, it’s much more difficult for psychologists, social workers and other behavioral health experts to team up with medical providers so they can help patients handle challenges that affect both the mind and body.

But, in primary care clinics, experts like Orlowski can seamlessly work with primary care providers.

“This model is primarily for the treatment of mild to moderate symptoms. We see patients for a multitude of health diagnoses including issues related to chronic illnesses such as diabetes and weight management, chronic sleep disorders and substance use, in addition to more traditional behavioral health concerns like depression, anxiety or stresses related to work or family issues,” Orlowski said.

She works closely with medical providers.

“It’s really helpful in terms of how easy it is to communicate with everyone on the care team. They’re right down the hall and we can work together to make sure the patient is receiving holistic health care,” Orlowski said.

“If a patient has started on a new medication, we can discuss how it’s going and if there are any undesired side-effects. I give the primary care provider updates on how the patient is doing, and it makes coordination nice and easy.”

For patients, seeing a psychologist or social worker at their primary care clinic can be a great relief. First, it’s usually faster and easier to get an appointment. Second, there’s no stigma.

No stigma, easy access to care

People coping with behavioral health challenges often feel very private about the help they need. Seeing a provider at the clinic where they usually get medical care can decrease any discomfort or hesitation about asking for help. Plus, patients get connected through their primary care provider, with whom they already have a trusting relationship.

“The primary care provider and I work very closely with each other. That offers a lot of comfort to the patient,” Orlowski said.

In addition to consulting closely with the primary care team, Orlowski can also tap psychiatrists since she’s part of UCHealth’s network of care.

In other settings, it can be very difficult for patients to get appointments with psychiatrists. Orlowski, on the other hand, can consult directly with experts at UCHealth University of Colorado Hospital, the only academic medical center in the region. Or, she can refer patients for appointments for Virtual Visits with psychiatrists.

“We have a psychiatrist available to help with patients who have more complicated psychiatric disorders. The patients meet with me first so I can evaluate treatment needs and to help confirm a diagnosis,” Orlowski said. “Then, I can consult with the psychiatrist as needed or we can help set up a telepsychiatry visit for the patient if it is appropriate. It’s a really great benefit that is fairly unique to the integrated health model at UCHealth.”

“If patients had to go to an outside agency to see a psychiatrist, they might have to wait a few months to get an appointment.”

A safety net

Colorado is like many states that have shortages of psychiatrists, psychologists and behavioral health providers. And, for decades, physical and mental health care systems have been fractured, forcing patients to seek care for physical problems in one system and mental health needs in an entirely different place.

To help offer better integrated care, UCHealth leaders launched a major initiative last year to dedicate more than $100 million over the next five years to address the behavioral health needs of patients throughout Colorado.

At least 380,000 Coloradans are not receiving the mental health care they need, while 67,000 residents require substance use treatment each year and about 1,000 people die of suicide each year in Colorado.

“Our model is to increase access while reducing stigma. Both lack of access and stigma have served as barriers to care throughout our state,” said Elicia Bunch, vice president of behavioral health for UCHealth.

“By integrating therapists into the primary care setting, we expand access and normalize seeking services. When you go to your primary care provider, you have your physical and emotional needs met in the same setting. We are treating the whole person in one location,” Bunch said.

Behavioral health experts have been joining UCHealth primary care practices since January and Bunch is continuing to add behavioral health experts. Patients who already see providers at those clinics are eligible to see the therapists.

“This is all part of UCHealth’s commitment to expand behavioral health services throughout our system,” Bunch said.

Primary care and behavioral health

“Given the emotional stressors associated with the COVID-19 pandemic, access to behavioral health services is more important than ever,” she said.

For experts like Orlowski, it’s wonderful to give patients the care they need in a familiar, warm setting. Her room looks just like a cozy therapist’s office.

“In community mental health, there is such a high need and there are not always enough providers for patients to be seen as frequently as might be recommended,” Orlowski said. “In other settings such as private practice, it can become quite expensive and many therapists do not take insurance. Patient access is a huge benefit of receiving treatment through an integrated primary care setting.”

Visits to UCHealth’s integrated therapists, on the other hand, are typically covered through insurance, just like any other primary care visit.

Orlowski sees patients in 45-minute sessions. She does the number of visits that she, the primary care provider and the patient deem to be necessary.

Along with her expertise as a clinical psychologist, Orlowski specializes in health psychology.

That means she has additional training to help patients navigate lifestyle changes that come with diagnoses for illnesses like heart disease or diabetes.

“I work with the patient and help improve motivation for change. I help patients create a plan to start making positive health and lifestyle changes that are necessary for improved functioning,” she said.

“I deal, of course, with traditional mental health diagnoses. But, I can also help patients who are having a hard time being compliant with a medication. If they are forgetting to take it, what can we do to make it easier? For patients dealing with obesity, what are some of the triggers for their eating? We can help with anything that requires behavioral change,” Orlowski said.

Many physical and mental health challenges are closely linked, and now the care for these conditions can be closely connected too.

“It has taken a long time,” Orlowski said. “But we know that integrated care is really effective.”

She urges people to seek help if they need it.

“Patients don’t need to feel like they’re alone in their challenges, especially right now,” Orlowski said. “It is such a great benefit and resource to receive treatment for both physical and behavioral health in one place.”