Sweet Tea and Mental Health Transformation

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.

The sad irony is that we have good tools to treat mental disorders successfully but less than half of those with mental illness get any treatment at all. Those who do are often forced to navigate a tangled maze that leaves them confused and feel-ing even more like outsiders. The truly integrated system we are planning here in Charlotte means that providers across all medical disciplines will gain a better understanding of how mental health affects their patients and, ultimately, the fiscal bottom line.

In April 2013, we broke ground for a new 66-bed psychiatric hospital. We’re building this hospital without state dollars . . . and without immediate plans to turn a profit. We’re doing it because it’s the right thing to do. This hospital is part of a vast new infrastructure that positions behavioral health as an integral part of a complete health care system. As grand as this plan is, it is historically consistent with Carolinas HealthCare System’s commitment to offer quality care to everyone-regardless of age, race, or financial or demographic status. One of every 4 people needs mental health care at some time in his or her life. If we ignore this need, the shock wave that results upsets the entire health care system. We’re betting that our investment in excellent behavioral health care throughout a large system will make good fiscal sense in the long run, particularly in a value- and outcome-based environment.

I could have (perhaps should have) waited until I’d fully acclimated to shout about this. The work of health care reform is daunting no matter where you are. But like the tea, there are unexpected surprises here in Charlotte. The first one came during my orientation program to this giant organization. Along with a hundred other new hires, I packed bags for hungry kids with donated food. Later I was in a breakout group focused on the company pillar of humility. Humility is generally a good thing in health care systems, but in mental health care-where our most corrosive villain is stigma-humility may be more valuable than gold. At my orientation, I saw Carolinas HealthCare System’s dedication to its patients firsthand. Clearly the change that is happening here will not be “top down” but instead driven by the needs of the community.

Across our nation, mental health care funding and resources are either slashed to the bone or nonexistent. Yet, at the same time, there is a unique opportunity available right now for any and all who want to tackle reform. Driven by national tragedies and the unsustainable nature of the current system, the American public is talking about mental health like we haven’t since the 1960s. Carolinas HealthCare System is not the only organization building a hospital and committing major resources to mental health care, but it is one of the precious few. To all those who are contemplating investment and doubling down on the bet that excellent mental health care will drive the bottom line, who want to turn the prevailing national story of the lack of resources and the steady drumbeat of hospital bed closures on its head, I say the news from Charlotte is like a refreshing jolt of sweet tea.