Care for the Whole Patient: Integrated Behavioral Health
A Virginia Mason patient for 32 years, Tom Cyr, visited his primary care physician with some familiar complaints. He had back pain, a side effect from hard physical labor, and his damaged knee — a decades-long condition requiring multiple surgeries — threatened to derail daily life. Tom’s doctor addressed those problems but was equally concerned about signs he wasn’t coping well.
“I was down,” remembers Tom. “Bad things had happened in my personal life. My doctor understood it even more than I knew it.”
Tom got an appointment that day with Megan Bott, LICSW, outpatient and Emergency Department social work supervisor, through a program integrating behavioral health care with primary care. Under the previous system, a patient might get in touch with social services by phone, and that’s where most interactions took place. Integrated services mean patients like Tom can see a social worker right away, for assessment and short-term counseling if needed.
Megan and Tom decided to meet regularly to start some basic cognitive behavioral therapy. Megan describes it as practical, skill-based therapy focused on identifying disabling thought patterns, reviewing what’s worked in the past and trying new approaches for problem-solving. Patients may have up to eight visits with the social worker, and be referred for continued mental health care when more support is needed. Megan and her two social work colleagues — covering Virginia Mason’s downtown Seattle and Kirkland locations — also provide crisis counseling, assistance to seniors, caregiver support, resources for people with special needs, and referrals for those dealing with abuse or addiction.
“For a primary care provider who realizes their patient is in distress, we offer a ready resource to support a variety of issues, often just in time,” says Megan. “After a diagnostic evaluation, we work closely with the physician, sharing observations and coordinating treatment to meet more of the patient’s needs.
Forced into early retirement due to health problems, Tom was already struggling when the death of one family member and serious injury to another left him feeling hopeless and adrift. In sessions with Megan, Tom revealed an interest in volunteering, but didn’t know where to start. Megan told him about volunteer opportunities at Virginia Mason and offered to help with the paperwork. Soon Tom had a volunteer badge and a new-found expertise preparing large mailings for the medical center.
“The volunteer work was my savior through the holiday months last year,” remembers Tom. “Megan helped me with a lot of things I couldn’t cope with at the time. I probably would’ve been in my doctor’s office every other week and that wouldn’t have solved the problem.”
After Tom’s counseling sessions with Megan, a referral to psychiatry was planned but not needed. Tom says they both figured he’d graduated. Still a dedicated volunteer, Tom’s looking forward to his upcoming partial knee replacement that should have him walking pain-free. “Megan made it clear her door’s still wide open,” says Tom.