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Clinician-to-Clinician Update

Psychiatry Clinic
West Building
2312 S 6th St., Suite F-275
Minneapolis, MN 55454 

Mental Health Neuromodulation Clinic
Park Place East
5775 Wayzata Blvd., Suite 255
St. Louis Park, MN 55416

Find more information about Psychiatry, Pediatric Psychiatry or the RABT program

To schedule a consultation, referral or appointment, call

Improving Access to Care for Common Mental Health Disorders

Anxiety disorders have emerged as the most commonly reported mental health disorder in the United States. An estimated 31% of American adults experience an anxiety disorder at some time in their lives, and 19% have been diagnosed with an anxiety disorder in the past year.1 The rate of anxiety among 18-29 year olds is similar (31.9%)2  to that experienced by adults overall, while the condition is reported more frequently in females than in males.1,2

Anxiety disorders include panic disorder, generalized anxiety disorder, phobias, including agoraphobia and social phobia, post-traumatic stress disorder, obsessive-compulsive disorder, and separation anxiety disorder. Depression frequently co-occurs with anxiety, and the DSM-5 recognizes these variants of depressive or mood disorder with its inclusion of the specifier “with anxious distress.”3  Approximately half of those diagnosed with depression are also diagnosed with an anxiety disorder.4 

Anxiety disorders are highly treatable, with several treatment options — including psychotherapy, cognitive behavioral therapy (CBT), and medication therapy, sometimes offered in combination — being recognized as evidence-based and effective. Support groups and stress management techniques, often offered in the context of CBT, are also effective. Nevertheless, only 36.9% of people experiencing symptoms of anxiety disorders receive treatment.4 Those who remain untreated face significant health risks.  

Treatment received at early onset of symptoms produces the most favorable outcomes. “Research tells us that early intervention is key, particularly for youth,” says University of Minnesota Health psychologist Emily Pisetsky, PhD. “Untreated anxiety and depression can lead to social isolation, interruptions in schooling, poor school performance, substance abuse, and later, difficulties with employment.” 

The challenge for providers is enabling patients in crisis to access services easily and quickly. University of Minnesota Health has expanded mental health services for more commonly diagnosed as well as serious mental health disorders, but the physicians have recognized that removing barriers to care remains a priority. In October 2017, University of Minnesota Health launched its Rapid Access and Brief Treatment (RABT) program, an initiative designed to offer quick access to time-limited treatment for adults experiencing initial episodes or recent symptoms of mental health disorders. The program provides a course of care running 3 months and is not intended for those with long-established, serious or persistent mental health conditions. The RABT multidisciplinary team includes marriage and family therapists, nurse practitioners, pharmacists, psychiatrists, psychologists, and social workers. Each patient meets with at least 3 providers for assessment, cognitive testing, and medication evaluation. Treatment plans are based on shared decision-making among clinical team members and patients.

“We’ve found that patients appreciate how the team comes together to create an integrated treatment plan so the patients aren’t managing multiple providers themselves,” says Pisetsky. After the initial visits, patients transfer back to their community provider with care recommendations from the RABT team.   

Symptoms often worsen over time when left untreated so connecting patients with treatment quickly is crucial. The multidisciplinary approach offers highly targeted, personalized, and coordinated interventions to patients early in the course of their illness to help alter the condition’s trajectory, Pisetsky indicates. 

University of Minnesota Health psychiatric services offer established programs for patients first experiencing psychosis, or symptoms of serious mental health disorders, such as the NAVIGATE and the Strengths Programs. RABT represents an extension of the efforts to provide early access to care.

References

1. National Comorbidity Survey (NCS). (2017, August 21). Table 1: lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort. Cambridge, MA: Harvard Medical School, 2007.  
2. Kessler RC, Chiu WT, Demler O, et al. Prevalence, severity and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):617-27. 
3. Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: classification and criteria changes. World Psych. 2013 Jun; 12(2): 92–98. 
4. Anxiety and Depression Association of America. Facts and Statistics. Silver Spring, MD: The Association, 2018. 

When to Refer

University of Minnesota Health psychiatric services offers care for a wide range of mental and behavioral health disorders and has worked to expand access. In addition to the newly launched Rapid Access and Brief Treatment program for patients experiencing initial, nonpsychotic mental health episodes, we have several specialized programs available, including the following:

The Early Stage Mood Disorders Program offers services to patients in childhood to early adulthood (up to age 25) who are experiencing symptoms associated with depression (e.g., sadness, low energy, feelings of excessive pessimism/guilt, thoughts of death/suicide) or when there are concerns about the presence of bipolar disorder (periods of elevated mood/energy levels and decreased need for sleep, grandiosity, impulsive/dangerous behaviors). Our multidisciplinary program provides comprehensive diagnostic evaluations, evidence-based psychotherapy, and medication management.

The Teen SUDz program serves adolescents 12 to 18 years of age who are experiencing the negative consequences of alcohol and other drug use. The outpatient team includes a physician, nurse, pharmacist, individual and family therapists who work with adolescent patients and their family or guardian to craft individual care plans.

Our First Episode Psychosis Program is one of the largest in Minnesota and includes the outpatient adult Strengths program for patients with an initial psychosis diagnosis within the past 5 years and NAVIGATE, a research-based intervention focused on helping individuals resume normal life activities.

Recently opened in the summer of 2018, the Behavioral Health Clinic for Families in downtown Minneapolis offers psychotherapy for patients of all ages.

Assistance for Community Providers

Community providers can connect with our programs in 3 ways. They can request a patient evaluation for ongoing participation in a program or an evaluation for a onetime consult, with the patient returning for ongoing care. Providers can also request a patient evaluation and brief stabilization treatment, after which the patient returns to the referring physician for care.


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If you have feedback about our service, please contact Levi Downs, MD, Chief Medical Officer: downs008@umn.edu