session HDM 03.13
Robin Henderson
Director, Government Affairs, St Charles Health
System, Bend, Ore.
Executive Director, Central Oregon Health Council
The Henderson File
◉ Past Chair, Section on Psychiatry and Substance
Abuse Services, AHA Governing Board
◉ Director, Behavioral Health Services, St. Charles
Health System
◉ Psy.D., Clinical Psychology, George Fox University,
Newburg, Ore.
◉ Past Chair, Section on Psychiatry and Substance
Abuse Services, AHA Governing Board
Interview by Elizabeth Gardner
Though mental health services take an occasional starring role in pub- lic discourse about health care, as they didafter the horrific December schoolshootingin Newtown, Conn.,
they’re mostly a bit player—ignored, underfunded
and only newsworthy when someone didn’t get
enough of them to avert tragedy. Robin Henderson, a clinical psychologist, could be accused of
bias for believing that improving mental health
care is key to improving overall care and controlling costs, but she recently proved her point with
a project focusing on “frequent fliers” in the emergency department. They were almost all Medicaid
patients, and almost all of them had some kind of
secondary mental health condition, addiction, or
pain, apparently unrelated to what had brought
them to the ED, and not severe enough to have
flagged them for medication or therapy. They were
referred for primary care to a “medical home”
setting that included behavioral health consultations. “They were instructed what to do if they felt
a migraine coming on, and what to do to reduce
anxiety,” Henderson says. The initial cohort of 144
patients had 44 percent fewer visits to the ED in
the first six months after starting the new care regimen, saving Oregon Medicaid about $750,000. “We
know that 12 percent of the people are responsible
for more than 72 percent of the [Medicaid] spend,”
Henderson says. “For us, that’s 3,600 people. We
can manage those people better.”
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I fought against EHRs initially [because of privacy
concerns], but now I think we have to change the
way we document [mental health information]
for it to be useful to primary care. It doesn’t need
to be a diary of everything in a patient’s life, but it
should show how mental health issues are impacting their ability to live, and what primary care can
do to help.
Healthy Minded
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We had a separate psych EHR at the hospital because the main EHR couldn’t accommodate our
needs. We built in a care and safety plan, and on
the first interview we asked patients what would
make them feel better if they started to get upset
or anxious. All the providers knew what button to
press to get that information, and doing what the
patients asked was often enough validation to get
them to calm down.
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There’s a group of patients with medically unexplained physical symptoms. They may have a good
relationship with a primary care doctor, but they’ll
come into the ED 12 to 15 times a year, and the ED
physicians will order tests. We create a care plan in
conjunction with the primary care physician and
flag their record: “If this person comes in, do A, B,
and C, and if those don’t work, follow up with me
tomorrow.” It saves a lot of expensive testing.
