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The Evolution Of Mental Health Care with Maria Oquendo, MD, PhD

Today, we have the distinct pleasure of sitting down with Maria Oquendo, MD, PhD. Dr. Oquendo is currently the Chair of the Department of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and a Past President of the American Psychiatric Association. She also serves as a Clinical Advisor to Mantra. In this post, we explore the ways in which psychiatry as a field is changing and what this means for patients in America. 

What is your perspective on collaborative care and how it relates to the future of psychiatry? What makes this model so important?

Collaborative care is the future of mental health (MH) care delivery. There simply will never be enough psychiatrists to provide MH care for everyone who needs it, so we need to be practical.  The system can be set up to be nimble and leverage psychiatrists to oversee care for a greater number of patients. 

How are you employing the principles of collaborative care at Penn? Why?

Here at Penn, we have been devising novel strategies to implement collaborative care.  We call it Penn Integrates Care. Piloting the program in 8 primary care clinics covering 100,000 patients is the first step towards a broader implementation. Not only does collaborative care provide a valuable service to our patients, it also has been embraced by providers including primary care doctors, therapists, and psychiatrists.

How can pre-screening help save time and money for patients without compromising the quality of the experience? How are you using this process? 

Using evidence-based tools and decision support software, we can devise clever ways to triage patients. Most will be well-served by a collaborative care model, and only a minority will need in-person specialty psychiatric care. 

What is the role of a coach (sometimes named care manger or patient navigator)? How are you thinking about this in your department? 

The conditions that we treat affect motivation and volition, so even the most willing patient may have difficulty following directions or adhering to medication regimens and keeping appointments. Coaches can help overcome these problems. As psychiatrists, we’re used to giving medications, but we’re not used to how scary it is for patients to take them. That’s another reason why coaches are so helpful.

Why do we need measurement-based care? Isn’t it enough to ask someone if they feel better or not? Why or why not? 

Measurement-based care is essential because patients will often feel so relieved if they are 30% or 50% better, that they might accept that as a reasonable end-point.  When you track symptoms using validated scales, you ensure that you know exactly how much better the patient is and how far they are from remission or recovery.

Can mental health care really be delivered via technology? 

We are learning more every day about how to leverage technology to deliver MH care. This will be especially true as younger generations who grew up with texting, Instagram and other social media come for MH care.

How can a patient know he or she is getting the best care, especially when using a technology platform? What advice do you have for patients considering getting their mental health treatment from a telehealth-based service?

Patients should use common sense in this decision.  How much support does the person need? Is there a method for tracking symptom improvement?  Are side-effects taken into account? Are things explained in a way that is easy to understand?  I would also advise people to trust their “gut feelings.” If there is discomfort about how things are going, it is crucial to speak up.