Painting by David Boyd, Jr.
It has been 6 weeks since my first sweet tea. Having traveled a good bit of the country, I would have thought I’d tasted most of what’s out there by now, but I was wrong. My first taste of sweet tea was a jolt, all at once familiar yet unexpected—much like my Southern experience so far.
Six weeks ago, my wife and I began the process of moving our life, 3 kids in tow, to Charlotte, North Carolina, from Connecticut, where I worked in the trenches of public psychiatry, doing my bit to improve access and care for those with mental illness. These things never go smoothly, but I had a good rhythm going in an outstanding agency and had great colleagues and patients. I even saw significant forward momentum.
What drew us to the South was an opportunity to be part of a much larger health care system that is poised on the leading edge of reform, including, remarkably, placing mental health front and center. Here, like everywhere else, patients are falling through the cracks, backing up in emergency departments, boarding in observation beds—or worse. Too often the severely mentally ill are caught up in the criminal justice system rather than receiving the medical treatment they deserve. Stable mental health should be no more optional than good cardiac care, but there are significant factors that conspire to keep that from happening. Stigma is one factor; cost is another and two others loom large: the current shortage of psychiatrists and other trained providers, and lack of coordination among caregivers.
Carolinas HealthCare System has quietly become the second largest non-profit health care system in the US, with 40 hospitals and 800 care locations in 2 states. If I thought the tea here in the South was a jolt, this large system is really shaking things up with an ambitious goal to lead health care transformation. Zeev Neuwirth, MD, Senior VP and Chief Medical Officer of Ambulatory Care and Corporate Health Services, speaks to this vision when he says, “The current trajectory of US health care costs is unsustainable and the increasingly complex needs of patients shouldered solely by the primary care physician is anachronistic. We need to shift the paradigm from providing episodic, fragmented care to an integrated, team-based, coordinated system that addresses the physical as well as psychosocial needs of patients across the continuum of their health care experience. Behavioral health care is an integral component of any such high-quality integrated delivery network.”
Carolinas HealthCare System is creating an integrated service line for behavioral health across the system, and I am here to help that hap-pen. We have invested millions of dollars in virtual technology in order to bring psychiatry into hundreds of our primary care offices. For example, we’re installing virtual technology that allows primary care providers to consult with a psychiatrist via computer teleconference. This innovation alone will allow a single psychiatrist to serve many more patients. It will also add collegial support to primary care providers, augmenting their skills and raising their awareness of mental health issues while ensuring better patient outcomes.