Care for the Whole Patient

Asset 2

(January 3, 2018) “I think that everything works better holistically than something that’s fragmented,” says Dr. Lemny Perez, Director of Behavioral Health at West Oakland Health Council (WOHC). Alignment of mental health, primary care and substance use service is driving the health center’s Behavioral Health Integration model, funded in part by the Alameda County Board of Supervisors.  The initiative aims to get the right care at the right time to West Oakland patients, including the growing homeless population living in the neighborhood’s encampments.

Perez reflects on how she and her colleagues see the change. “Before, you might come here from a different clinic for methadone or for substance use and receive primary care elsewhere.  Also, in the past, folks used to think you first had to address the substance use issue and then deal with the mental health.  Now we are realizing that those two things are co-occurring. Our integration model aims to address the whole person without these silos that inhibit the person from receiving services that are going to be supportive to their overall well-being.”

An Integration Model

The integration model features:

  • Outreach into homeless encampments
  • Outreach to community resources and centers
  • Training providers in SBIRT (Screening, Brief Intervention and Referral to Treatment)
  • Internal outreach with existing patients

Internal outreach entails scanning all primary care patients and looking at any of their assessments that might reveal elevated depression or substance use. Identified patients will get a call.

“We know that if you call someone and ask ‘do you have depression?’ you will likely get ‘No, there’s nothing wrong with me.’ But if you ask about whether they are experiencing stress, (you get a reply). It’s a more benign question.” Patients needing care then get referred to stress management class.  “And from that class we’ll be able to triage and identify people who need dental services, who need optometry, or substance use (treatment).”

Identified patients will get direct visits with a mental health provider and suggestions for wellness classes held at the health center. In addition to cessation classes, yoga, massage and acupuncture, WOHC will also offer options that are “culturally responsive to the community that’s here” like drumming and dance.

Getting to Wellness

Perez’ past experience in a pain management clinics inform the program. “Working with people who were coming off of their opioid dependence, what I noticed was that the vast majority of folks needed was not to be isolated …to have the opportunity to be with others who are like them and to whom they can be supportive.”

Support from the County of Alameda for two years fuels the pilot, and Perez and colleagues appreciated the collaborative process and support from the County.

Perez recognizes the importance of staff undergoing mindfulness and wellness interventions along with patients. Staff experience stress management and mindfulness practices, including daily ringing of bells at all the morning huddles.

Moving Forward Together

“This is wonderful work. We have a long way to go. We have a vision and the population is here, the encampments are in our backyard. We have a responsibility to do something about what’s going on in our community.”

Along the road to integrating behavioral health at WOHC, Perez sees a growing role for collaboration among health centers across the Alameda Health Consortium. “At the end of the day, our patients are going from one clinic to another and we are all sharing them. The closer we work together, the more walls that are incinerated, the less silos that there are, the more services we will be able to provide.” (Dr. Perez is pictured with a photo of WOHC founding board member Cloteal Davis)