Coordinating care for mental and physical healthQ&A with Pallavi Munikrishna: Nonprofit Journal Project

Pallavi Munikrishna is director of Integrated Health Services and CCBHC (Certified Community Behavioral Health Clinic) at Development Centers, a human services nonprofit organization in Detroit. Development Centers’ services include mental health, adult employment and training, and early childhood programs.

At Development Centers, what does integrated health care mean?

Integrated health care is basically combining, or better coordination between, physical health and mental health. It is more than just having both offices in the same building, but an approach to services where staff from each discipline talk to each other about what is happening regarding all health aspects of a person.

How does this approach compare to the traditional model of treating mental health and physical health needs separately?

There is better coordination, better follow up—and we have more comprehensive services and advocacy. When someone comes through our doors for mental health services and they also need to see a primary care provider; this is a great opportunity for integrated care. If there is no primary care established, we refer them immediately for those services and follow up. Once the services start, the primary care provider, psychiatrist, clinician, case manager, and pharmacist periodically come together to talk about the case. We talk about the barriers we are facing or improvements we are seeing, first on the physical health side, and how does it translate on the mental health side? With the clinician and case manager being a part of this case huddle, they are better able to understand what is working and what is not from the different departments. And when they meet with the consumer next, they come up with a holistic plan to address barriers or advocacy.

You have several different locations, and some have primary care physicians on site, correct?

Correct. At one location on East McNichols in the east side of Detroit, we have had the integrated care piece for close to 30 years. We have in-house pharmacy, primary care, and behavioral health. We have a second location where primary care services are scheduled to begin on site in June. Other locations offer just mental health. All sites utilize the same electronic medical record, so even if consumers switch locations, their charts are accessible by staff at any site. 

How has this integrated health services approach evolved over the years?

The complexity and difficulties of health care during the pandemic caused some challenges with integrated care. As consumers and providers began more remote services, we incurred challenges with truly integrating care. But we are moving towards bringing more services back on site and in person.

We have seen a decrease in hospitalization for mental health issues. It can be especially challenging for people with mental illness to be proactive in taking care of their physical health, especially dental needs. Having integrated health has led to better health outcomes for them—less hospitalizations, not only for behavioral health, but also for physical health, like stroke and diabetes, too.

How else does Development Centers make health services accessible to the people who need them?

We are currently a CCBHC agency—Certified Community Behavioral Health Clinic—which is a federal program that helps provide integrated care services for people who don't have insurance and for people who are underinsured. For example, if someone has no insurance but wants to see a doctor and has mental health issues, we step in, and we are assisted by grant dollars to help them apply for Medicaid, help them access physical health services, as well as get services for psychiatry. We will assign a case manager, and the case manager will advocate at every step. We assist underinsured consumers in linking to and coordinating with services available within Development Centers. We offer same-day and next-day appointments, so that there is no delay when someone reaches out to us.

Your CCBHC services are tailored to certain populations. How that works?

Our major focus for our grant includes three areas: veterans, the LGBTQ community, and people struggling with substance use disorder. We have clinical and non-clinical staff, which includes the support staff, who are specially trained in all of these areas and making sure that our services are culturally sensitive. We hire clinicians who are trained with trauma-focused cognitive behavioral therapy and have a substance use licensure, which is often especially helpful for the veterans and LGBTQ community.

Have you seen any trends in the services that people are needing more?

Post-COVID everywhere, there is a sense of grief, loss, isolation, depression, and the changing priorities and expectations in society. Because we offer same-day, next-day intakes and very quick access to a prescriber, the quick turnaround is one of our best tools to help people who reach out to us. We're also partnering with a lot of social agencies and groups in and around our communities, like block clubs, the local police precincts, and churches. We go and talk about our services, how they can access them, and what is the timeline they can expect. We have been doing a lot of outreach in the community.

The biggest challenge is staffing. The pandemic resulted in a sharp increase in the demand for mental health services, and there just aren’t enough licensed staff to provide all of the help that is needed. We have been focusing on self-care for our staff, because they're also going through some of the same stuff our consumers are going through, so we are making sure they are taking care of themselves as well. We have group wellness sessions every other week with an outside therapist. And our managers and directors have been trained in staff self-care and identifying burnout.

What are you looking forward to in the coming months?

We have an upcoming partnership with an FQHC (Federally Qualified Health Center), with primary care and dentistry, that's going to be offered at one of our locations. We also just submitted our next improvement and advancement CCBHC grant.

We are also looking to center our partnerships for substance use disorder with the Detroit Recovery Project and Elmhurst Home. We're also strengthening our physical health navigating team. We have someone who's been trained in the social determinants of health, which focuses on not just physical and mental, but also economic, geographical, housing, educational, vocational—all those wraparound services.

This entry is part of our Nonprofit Journal Project, an initiative inviting nonprofit leaders across Metro Detroit to contribute their thoughts via journal entries on how COVID-19, a heightened awareness of racial injustice and inequality, issues of climate change, and more are affecting their work--and how they are responding. This series is made possible with the generous support of our partners, the Michigan Nonprofit Association and Co.act Detroit.
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