Integrating Mental Health Care in the Medical Setting

Inside this story:

• Hogg Foundation awards $440,000 to support the Integrated Behavioral Health Scholars Program at Dell Medical School, University of Texas at Austin
• Interdisciplinary training prepares medical and behavioral health students to collaborate on patient care in integrated care teams.
• An expanded curriculum focuses on building cultural competency and helping students develop a deeper understanding of social determinants of health.
• Through coursework such as the Understanding Homelessness course, the curriculum strongly emphasizes experiential learning and lived experience.

Because mental well-being exists in close relationship to physical well-being, patient care that integrates mental health care into physical health care can have a more meaningful and lasting impact than treatment for each in isolation. And when integrated care teams also understand and address how social and environmental conditions impact mental health, patient outcomes can improve even more.

In many health care settings in Texas, however, general mental health care is lacking, much less integrated care. Over 75 percent of Texas counties are in mental health professional shortage areas and Texas ranks second to last nationally in mental health workforce availability and overall access to mental health care for youth and adults.

Also lacking are educational opportunities that aim to increase students’ awareness of and sensitivity toward cultural and social variables that impact a patient’s mental well-being.

In response to these urgent needs, and with the support of the Hogg Foundation and the Health Resources and Services Administration, the Dell Medical School, The University of Texas at Austin, (DellMed) launched the Integrated Behavioral Health (IBH) Scholars Program at UT Austin in 2017.

The Hogg Foundation awarded $440,000 to DellMed for the project. The overarching goal was to develop a team-based learning curriculum that engages students from across disciplines in the best practices of integrated behavioral health care.

“The interdisciplinary IBH Scholars Program aimed to prepare medical and behavioral science students to provide culturally competent and evidence-based mental health services in integrated primary care settings for underserved communities in Texas,” said Lloyd Berg, PhD, ABPP, Program Lead IBH Scholars Program and Division Chief of Psychology in the Department of Psychiatry and Behavioral Sciences at DellMed.

Ninety-one percent of IBH Scholars are working with medically underserved communities in Texas. The IBH Scholars emphasis on guiding students into professional practice with underserved communities has been key to its success. 

Working as a Team

In pursuit of these goals, many IBH students received their clinical training at UT Health Austin, the on-site medical clinic at DellMed. 

“What’s unique about UT Health Austin is that it already works with a collaborative care model,” says Kathryn Flowers, MPAff, the initial education coordinator for the IBH program, and current Assistant Director in the Department of Psychiatry and Behavioral Sciences at DellMed. “Specialists from multiple disciplines care for the patient as one full team: the social worker, the doctor, the physical therapist, etc. Whatever the specific needs of that patient, all of those folks collaborate on that person’s care in one place.” 

Embedded in these collaborative care teams within a variety of clinics, including Women’s Health, Cognitive Disorders, Musculoskeletal and Primary Care, students gained valuable experience integrating mental health care into many different medical settings. 

Learning from Lived Experience

In addition to the clinical training, DellMed developed coursework to help students recognize how social determinants and personal biases might also affect patient outcomes.  

Students found the Understanding Homelessness course, developed in collaboration with homelessness advocate Val Romness and a number of her colleagues with lived experience, especially powerful. “The experience was completely altering for some of them both professionally and personally,” said Flowers. 

Aimed at fostering empathy and preparing students to provide compassionate care for people experiencing homelessness, the course included a strong experiential learning component. In addition to an overnight homelessness simulation, students took guided tours of the downtown homeless shelter, soup kitchens and ‘tent cities’ by people with lived experience of homelessness. Grant personnel, including Flowers, worked in partnership with unhoused youth at the Austin Youth Collective to create a digital, interactive teaching tool, Voices from the Street. In the classroom, students learned from a variety of community advocates, including Dianna Grey, the City of Austin’s Homelessness Strategy Officer, Tim Mercer, MD, Director of the Mobile, Medical and Mental Health Care Team, and representatives from Austin ECHO, Integral Care, CommunityFirst! Village and Trinity Center.

“I appreciated getting to hear from people with lived experience and felt like I was able to change a lot of assumptions I previously had on homelessness,” said one student. 

“I learned so much. I’ll carry the stories I’ve learned through this elective with me throughout my journey in medicine,” said another. 

The IBH Scholars Program has now graduated 149 scholars across four disciplines (Psychiatry, Psychology, Social Work, and Nursing) in four years. Its emphasis on guiding students into professional practice with underserved communities has had strong results. 

Significant Contributions

The IBH Scholars Program has now graduated 149 scholars across four disciplines (Psychiatry, Psychology, Social Work, and Nursing) in four years. Its emphasis on guiding students into professional practice with underserved communities has also led to impressive outcomes. 

Ninety-one percent of the first three graduating classes are working with medically underserved areas in Texas. Of these classes, fifty five percent are working in integrated settings and twenty three percent are working for public sector agencies. Of the fourth-year graduates, eight have already secured full-time positions, all of them working with medically underserved populations. 

The new curriculum, and the Understanding Homelessness course in particular, have also led to some unexpected successes.  

“I think we did some things we never set out to do, like building relationships between UT Austin and people in our community who are unhoused,” said Flowers. “Our ability to build relationships with them changed how they thought about the school and gave them a positive impression of what we’re trying to do. We set out to educate medical students. We didn’t realize we were also going to be building a sort of bridge to the community and fostering trust.” 

Looking to the Future

Since receiving the 2017 grant from the Hogg Foundation, DellMed has secured five additional grants that will ensure its continued growth and development. In total, $8.68 million in additional grant funding spurred by the Hogg Foundation’s initial investment will now provide financial support for the IBH Scholars Program. 

Participation by medical students grew over each year of the program and is expected to continue to grow. Feedback and course evaluations from students have also been consistently positive, and “the medical school has expressed interest in incorporating components of the Understanding Homelessness course into the wider medical school curriculum,” said Berg.   

The reach of the IBH Scholars Program is also expanding. With expert guidance from the Austin Youth Collective, DellMed developed an online pilot program of the Understanding Homelessness course and shared it with five additional learning institutions around the state. 

 “We developed this curriculum to help interdisciplinary health professionals serve people experiencing homelessness through a better appreciation of their lived experience. This curriculum could also be utilized in a variety of other formats, such as educational or training materials for nonprofit organizations or government personnel,“ said Berg. “So far the feedback has been fantastic.“ 

Berg and Flowers remained committed to the goals of the IBH Program, pleased with the results so far and optimistic about its continued impact in the future. As expressed in the grant’s final narrative report: “The results have been transformative for health care education at UT Austin…and we hope we can continue to amplify the impact of our work to improve care.” 

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