It is a startling and sad fact that individuals with serious mental health problems on average die earlier than those without mental health issues. An article in JAMA Psychiatry reported that these premature deaths are primarily due to largely preventable conditions, such as high blood pressure, high cholesterol, diabetes, and heart disease. In 2013, the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration reported that one of every three adults with mental illness smokes cigarettes, compared with one in five adults without mental illness. Individuals with substance use disorders are also likely to have a shortened life expectancy. While the reasons for these outcomes are vast, all point to the need to expand efforts to address the inextricable link between physical and behavioral health.
In an effort to help clients live healthier and longer lives as well as support our therapists and psychiatric staff so they are better able to provide the services which they are uniquely qualified to offer, WJCS, the largest community-based provider of licensed outpatient mental health services in New York’s Westchester County, launched a pilot program in 2012. Licensed Practical Nurses (LPNs) were hired to enhance the integration of mental health, substance use, and physical health treatments as well as boost staff efficiency. Seven years later, this program is a well-established, vital, and valued model that validates the benefits of expanding the traditional behavioral workforce model to include LPNs.
There are multiple factors that make integrating LPNs into the behavioral health treatment model beneficial. The United States is facing a crisis of profound impact: the shortage of medical doctors, including primary care physicians, psychiatrists, and doctors specializing in addiction. Access to much-needed care is becoming increasingly challenging for consumers as well as for health and mental health organizations who must maximize the efficiency of practitioners. By integrating LPNs into our behavioral health model, WJCS is now able to provide more comprehensive care to a higher volume of clients and is positioned to better meet the needs of our clients and communities in a managed care environment.
The presence of LPNs in our clinics has allowed us to expand our capacity to conduct medically necessary screening of consumers in areas that are known to contribute to long-term negative health outcomes. In addition to our other providers, our LPNs, trained in motivational interviewing, screen clients for tobacco and alcohol use, help clients explore their desire to reduce or end their use of tobacco, aid clients in obtaining nicotine replacement therapy or medication-assisted treatment, follow up with clients and communicate with their care providers to successfully reduce harmful substance use.
Our LPNs help us to identify clients who are at metabolic risk by tracking PSYCKES data and through regular screening. They ensure that clients obtain the medical lab work necessary to ensure medications prescribed are appropriate for the client’s health profile and to monitor for reactions to medication. LPNs conduct real time screening of clients for substance use, via breathalyzer or on demand urinalysis, when our psychiatric providers are prescribing controlled substances in order to minimize the risk of adverse medication and substance interactions.
At WJCS, LPNs have been instrumental in helping to identify clients in need of outside care as well as facilitating that care. At intake screenings and at an annual wellness screening, LPNs review client health concerns and actively connect them to medical providers, often going as far as calling to schedule a doctor visit for consumers who are not connected with a primary care physician or who have not had a physical in the last year. Krystle Colon, Supervising LPN at the WJCS Yonkers Family Mental Health Clinic states, “Clients see me as an extension of their care team and if they have some pressing or, perhaps, embarrassing health concern, they will come to me and ask about it. It’s gratifying to see them address health concerns and increase healthy behaviors.”
On occasions when they have identified a grave medical concern, such as unmanaged diabetes or very high blood pressure, LPNs have walked clients over to a medical provider’s office. In each case, the LPN follows up with the client to be sure he or she has received needed care. The LPN also brings these matters to the awareness of the client’s therapist and psychiatric providers.
As a result of LPNs conducting wellness screenings prior to initial therapy appointments, our mental health practitioners are armed with comprehensive health information at the time of the appointment and freed up to focus on the needs of the client. By having LPNs complete prior authorizations of medications, address concerns regarding medications and medication refill requests, and respond to emergent medical concerns, our system of care is better able to respond to client concerns in a timelier fashion and is also able to offer services to more individuals. LPNs have also begun assisting our psychiatric providers with urgent care walk-in hours by prioritizing clients by need, collecting vitals, completing necessary medical tests, and identifying concerns so that the time with the psychiatric provider is optimized.
Challenges to integrating LPNs in our mental health clinics do exist. Most of the services our LPNs provide are not reimbursed through commercial insurance companies. Adding LPNs to our workforce has added a financial cost but it has enabled us to provide high quality integrated care, which can be life-saving. Additionally, integrating LPNs into our workforce in the ways described above requires much thoughtfulness in the development of workflows to ensure all staff are working at the top level of their licensure. WJCS clinicians welcomed the LPNs, after witnessing the full value of such changes to our clients, our communities, and to the providers themselves.
In summary, the addition of LPNs to the behavioral health team at our WJCS Article 31 Community Mental Health Clinics is helping to enhance our capacity to provide the highest quality health services to the consumers and communities we serve. It is our goal that through innovations like those mentioned, we enable clients to live longer, fuller, and healthier lives, reversing the trend of shortened longevity and more negative health outcomes in people who experience mental health issues.
WJCS-Westchester Jewish Community Services provided mental health services to 3,900 individuals in 2018. For more information, please visit www.wjcs.com or call (914) 761-0600.