Apr. 23--Dr. Heidi Miller, an internist in the Forest Park Southeast neighborhood, knows her role as a primary care doctor can sometimes extend into treating complex psychiatric disorders.

She once treated a patient who was recently released from prison. He had violent thoughts, but they were not severe enough to call the authorities or have him committed to a psychiatric hospital. Miller tried calling private psychiatrists and even academic psychiatrists in hopes of finding a physician willing to help, but no one was interested.

Miller did the best she could, and eventually the patient stopped showing up for appointments, but she always worried she didn't do enough.

"I'm a good doctor, but I can't do brain surgery and I can't take care of complex psychiatric disorders," said Miller, who works for Family Care Health Center, a federally qualified health center. The center receives government funding to offset the cost of patients who cannot afford to pay.

With too few psychiatrists in the area, especially ones interested in caring for those

without insurance, Miller says she's often forced to "try her best" for patients who need the expertise of a specialist.

Family Care is trying to change this with a program that integrates mental health services with primary care. The health center hired a psychiatrist who splits his time between Family Care's two locations and a third job.

The psychiatrist, Dr. Jaron -Asher, is helped by the Family Care's small staff of mostly part-time employees. Those professionals include a psychologist who specializes in treating children and a social worker who handles case management.

The concept of merging primary care services with mental health services has been tried successfully elsewhere. Though some preliminary studies have shown benefit, physicians are interested in learning more about how these collaborations work. The Hogg Foundation for Mental Health launched its Integrated Health Care Initiative grant program last year, giving five organizations nationwide more than $2.6 million over three years. Their aim will be to promote the effective identification and treatment of mental health problems in primary care settings.

Locally, Crider Health Center, which provides mental health services, has hired an internist to help with patients' primary care needs; and Grace Hill Neighborhood Health Center, another federally qualified health center, is collaborating with BJC Behavioral Health.

At Family Care, patients in need of mental health services typically fall under three categories. For those with depression and other less complicated conditions, Miller treats the patient but can look to Asher for assistance, even informally through an e-mail or phone call. Others are first evaluated by Miller and then sent to Asher for follow-up. These patients either remain under Asher's care for their psychiatric diagnosis or can be monitored by Miller after medications are established and they are stabilized. Patients must be referred to Asher by Miller or another of the office's primary care physicians.

The integration of services has benefited Asher and Family Care's physicians in other ways as well. Patients have one chart, so Miller and Asher can see other medications patients have been prescribed and whether they showed up for follow-up appointments with other staff members.

"That kind of information flow almost never happens," Asher said.

The integration plan was originally Asher's. He wanted to see patients who needed help, but who couldn't afford time with a private psychiatrist.

He asked his wife, who has a master's in business administration, to help him develop a business plan to present to Family Care's board. The board quickly agreed, and Asher began seeing patients in February.

"We are extremely relieved that he is here," Miller said. "This collaboration between mental health and primary care is more revolutionary than it should be."

mjfeldstein@post-dispatch.com

314-340-8209

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Last updated: 05/01/2008 - 03:06 PM