As I listened to Suzanne* on the phone, she started crying as she described how she was left without insurance for several months because of a confusion with her retirement. She told me she didn’t have a secure place to live and bounces from place to place. Most pressing to her was her lack of insulin- it had been 5 days without it. The pharmacy wanted to charge Suzanne over $400 for her insulin and she couldn’t afford it.
I had called Suzanne to check in on how things were going with her depression. Although my main focus is on treatment for depression, such as whether patients are taking their medicine or whether they see a therapist, I had called at a critical time when Suzanne needed help with her physical health. I connected her to our Social Worker and our Chronic Care Management, who helped register Suzanne for Medicaid. We referred her to a free clinic before her insurance took effect and now that she has insurance, Suzanne has been seen at the clinic to manage her diabetes. I am able to connect patients with various resources to help their physical and mental health as much as possible.
Another patient, who I will refer to as Mary, was seen in March with severe depressive symptoms. She was suicidal and hearing voices. The doctor prescribed her an antidepressant, but Mary was scared of its effects, so she stopped taking the pills after a week. Mary didn’t follow-up about her depression and none of her doctors asked her about it in the subsequent months. When I called over 6 months later, Mary was still experiencing the same symptoms. Nothing had improved and if anything, she had less trust in the medical system because she believed that she fell through the cracks. Because I called, I was able to help get her scheduled to see our psychiatrist. I joined our psychiatrist during her office visit and listened to her history of childhood trauma. Now, I will call and meet with Mary in the office throughout her treatment for Major Depression and PTSD to help the process go as smoothly as possible.
Depression is the most prevalent of mental health disorders, affecting roughly 20% of the US adults in their lifetime (1). Most adults choose to start their treatment with their primary care provider, making it important to integrate behavioral health treatments with primary care.
One of my main roles at Shadyside Family Health Center is to call depressed patients in between their visits to see how things are going. I’m able to provide support and encouragement, and to help problem-solve any barriers that might be limiting their treatment. It’s important for these patients to have another resource in between office visits and another person looking out for their mental health. To do this, I manage a database of our patients with depression, which I update every day to identify patients in need of follow up. I work on a team with our psychiatrist, primary care providers, therapist, and social worker to make sure no one’s mental health treatment falls through the cracks.
This post was written by NPHC member Annie Davis.
Annie serves at UPMC Shadyside Health Center as a Care Coordinator.
*Names have been changed to protect patient identity