Friday, August 28, 2015

The key to better mental health care is sharing records

Just because a surgeon is only operating on your toe does not mean that your overall mental state is irrelevant.

The key to better mental health care is sharing records

Just because a surgeon is only operating on your toe does not mean that your overall mental state is irrelevant.
Just because a surgeon is only operating on your toe does not mean that your overall mental state is irrelevant. iStockphoto

“Treating the whole person includes mental health care.” That statement was the title of a commentary written by the American Medical Association president, Jeremy A. Lazarus. Dr. Lazarus recognized that physicians can best treat their patients if they integrate mental health and mental illness into overall medical care.

A recent Johns Hopkins University study indicated that this integration is far from complete. The study, which surveyed the US News and World Report top 18 hospitals nationwide in 2007, found that only 44% maintained most or all of their psychiatric records electronically, only 28% made psychiatric records accessible to non-psychiatric physicians, and only 22% did both.

The study also showed that mental health record integration has promise – of the 18 hospitals surveyed, those that shared mental health records with non-psychiatrist physicians had significantly lower readmission rates for 2,000 psychiatric patients.

These results are important, particularly at a time when mental health should be on the forefront of our minds. From the courthouse slayings in Wilmington to the Lower Merion officer who committed suicide in a city park, this week’s local news alone makes it apparent that something must be done to address mental illness.

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Furthermore, mental health is a major aspect of overall medical care. For starters, medication used to treat mental illness can interact with other medications prescribed to treat physical conditions. Additionally, medical providers oftenneed to know a patient’s mental health status. For example, the physicians and nurses treating a patient waking up from general anesthesia might benefit from knowing that he or she suffers from hallucinations. Just because a surgeon is only operating on your toe does not mean that your overall mental state is irrelevant.

Mental health records are given higher confidentiality protections to protect patients from the stigma of a mental health diagnosis. Patients often have a heightened concern that their mental health records, more than physical health records, can cause them harm if released.

Nevertheless, many patients understand the importance of integrated care and would consent to sharing their mental health records with non-psychiatric physicians; however, many institutions allow patients only two sharing options: all or none. Patients are not permitted to share only designated portions. Whether this is due to technical difficulties or to the logistical challenges of state laws requiring two separate consents – one for physical health and one for mental health records – the result is often that mental health records are not available for integration with other patient information.

With recent tragedies, like the ex-LAPD officer who went on a vengeful rampage killing three people and the horrific Sandy Hook shootings that left 26 innocent children and educators dead, there is no better time than now to focus on how to improve mental health care. And if the Johns Hopkins study is any indication, mental health record integration may make a difference. Despite the technical and logistical challenges, we must make it happen. Your life and mine may depend on it.

- By Erica B. Cohen

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The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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