Table 2 Illustrative quotations from participant interviews
Domain | Theme | Participant Group(s)1 | Quotation |
|---|---|---|---|
Barriers | Waitlists & capacity limits | PCC BHC Pt L | “When we are fully staffed, we’re getting to people very quickly. But we are seriously understaffed and there’s a huge need right now, so that’s just not the case. We are significantly backed up in our outreach to patients to screen them, engage them, and we lose people in that wait time.” (Behavioral Health Clinician) |
Insurance | PCC BHC Pt L | “I find the majority of the patients who I encounter who, you know, come from a more turbulent situation, generally have less adequate insurance… So, I’ve had very great difficulty connecting some of the most high-need patients with appropriate care. And that’s a systemic issue that is very difficult for me to rectify on my end.” (Behavioral Health Clinician) | |
Patient factors | PCC BHC Pt L | “…We have plenty of folks that are struggling with psychosis, or, um, substance use, that just- they’ve already been to the same two places, and they had- they say they had bad experiences. They’re perceiving they had bad experiences, or they did have a bad experience, and they don’t want to go back there.” (Behavioral Health Clinician) “I just mentally am so drained, and exhausted, and frustrated where I just don’t even feel like talking to anyone… Sometimes, I can just shut down. When I shut down, I will not go to the appointment, I will not make the phone call or take the call because I just don’t…I’m not able to physically and mentally handle it.” (Patient) “Sometimes people are struggling with so many different problems, like [psychotherapy] doesn’t feel as relevant as trying to work and put money on the table.” (Community Mental Health Leader) | |
Communication & collaboration breakdowns | PCC BHC Pt L | “I’ve had patients who I’ve lost contact with during the course of like, following up.” (Behavioral Health Clinician) “…when it’s that difficult to get an appointment, and it’s not life or death, I think patients will just give up on it if it’s too difficult.” (Patient) “But I think we sometimes lose the momentum when in that moment I have them, they’re interested, they’re agreeable, and then there’s this step to saying, ‘well, you have to call, and there might be a fee.’ And I think those two things kind of deter people.” (Primary Care Clinician) “Sometimes, you know, patients are admitted to the hospital for a suicide attempt or see their mental health provider and there’s not as much communication that happens.” (Primary Care Clinician) | |
Facilitators | Telehealth | PCC BHC L | “It’s allowed us to service a population that we may not have reached before, because they couldn’t come in between nine to five.” (Leader) |
Integrated care | PCC BHC Pt L | “Part of why I do this integrated care work is because I do feel like we can improve access, right? Just by simply having a human on-site when [patients are] seeing their pediatrician. Just saying [to patients], “Gosh, we have somebody here in the building, would you like to meet them?” And even if I can’t meet them, having that relationship with the doctors, with the providers, to say, “Hey, I have a kid that needs care.” Instead of putting in a referral– like, it’s stuck in a queue somewhere.” (Leader) | |
Scheduling assistance and flexibility | PCC BHC Pt | “One of the things overall that works really well is the fact that we have a lot of reserve for same day and next-day appointments.” (Primary Care Clinician) “I think evening– more evening hours would be helpful, now that I think about it, for availability for people. Um, weekends. I think that’s a huge piece, as far as– and in an ideal world, availability.” (Behavioral Health Clinician) | |
Psychoeducation and motivational enhancement | PCC BHC Pt | “And so, I try to provide a lot of psychoeducation about how to find a good therapist, and you know- therapy is a tool, and you can- you don’t have to be in therapy for the rest of your life, you can go to therapy, you can find someone who knows about the specific thing you’re going through.” (Behavioral Health Clinician) “A lot of times it is kind of just explaining where I’m coming from, why I’m asking the questions (about suicide risk), um, that is really helpful.” (Leader, speaking from their clinical experience) | |
Reminders and support | PCC BHC | “If I have [a patient] in a high-risk episode, then I will continue to follow up with them… I call them, and say, “Have you been able to contact this person? Why or why not?” (Behavioral Health Clinician) “Having people that are kind of there every step of the way to you know, say, ‘Hey, you’ve got an appointment coming up, here’s a reminder.’ A week ahead, the day before, so on and so forth. Just kind of checking in, ‘Do you have a plan to get there? Do you know how you’re going to get there? Do you have money to get bus fare if that’s how you’re getting there or if you’re driving? Or however you’re getting a ride.’ And helping kind of problem solve every step of the way.” (Behavioral Health Clinician) | |
Suggestions | Increase communication and collaboration between primary care and mental health | PCC BHC Pt L | “I think shared communication, or documents, or charts or something between primary care therapist and psychiatrist…so that they would easily be able to pull up the same information. I wouldn’t have to like explain things over again” (Patient) “Let’s say we needed to access, like, a higher level of care. Then ideally, I would love for that to be built into the system, right? So then it’s kind of a warm handoff to that next level of care, they don’t have to go through an intake process again…we [would] have a direct referral process to that.” (Community Mental Health Leader) “It would be great to have more of a network of other providers in the city, to be able to… be more in tune with different agencies.” (Behavioral Health Clinician) |
Streamline referral and intake processes | PCC BHC L | “It would be really great if there was a system in place that allowed there to be some type of affiliation agreement where we can get those families to that next level, [to] be able to identify who those folks are in the community, um, and have kind of a more streamlined referral process.” (Community Mental Health Leader) | |
Reminders and Follow-Up | PCC BHC Pt | “It would be really great to have like…because I know [the health system] does this for some things, but like sending out reminders and to be able to customize them would be pretty cool. I can say if I need to know an hour in advance that I need another reminder a half an hour in advance or something like that or even a third reminder one day in advance because for me all of those reminders make the best chance that I’ll actually show up at an appointment.” (Patient) | |
Advocacy | L | “We need to improve reimbursement rates so that we can do a better job recruiting and retaining highly trained providers to provide care.” (Leader) “We are responding to a CMS request for information right now, which is specific to potentially underutilized Medicare services, including behavioral health integration. So, we are advocating to CMS for a few reasons. We think they need to address the reimbursement for collaborative care codes… just reimburse for uncompensated costs… what’s very hard though is the implementation costs, the programmatic oversight, and the financial investment in the technology, just to keep collaborative care afloat… It’s so complicated with the service components to even meet the codes.” (Leader) |