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Riverwood Healthcare-McGregor

Janet Larson

Mental Health Integration Essential to Riverwood Healthcare's McGregor Clinic

“If people aren’t mentally healthy, we’ll never get them physically healthy,” said Janet Larson, psychiatric nurse practitioner. Larson began as a family nurse practitioner, but 14 years ago went back to school for her psychiatric certification. Subsequently, together with Tim Arnold, MD, she began integrating behavioral health into primary care at the Riverwood Healthcare McGregor Clinic.

“Mental and physical health are strongly interconnected, so integrating behavioral health into our primary care model and delivering those services in a single location is essential to fulfilling our commitment to the patients and communities we serve,” said Chad Cooper, Riverwood Healthcare chief executive officer.

“When I was in family practice, I saw many patients with diabetes who were depressed,” Larson said. “I knew we had to improve their mood in order to help them.” Today, Larson sees patients at the McGregor, Garrison and Aitkin clinics with all forms of mental illness, from schizophrenia and bipolar disorder to PTSD and anxiety. “Our very vulnerable patients are well cared for,” she said. (Learn more about ICSI’s related work on COMPASS, a collaborative care management model designed to improve the care of patients with depression and diabetes and/or cardiovascular disease, and possibly risky substance use.)

A typical scenario begins when a physician, nurse or other staff member identifies a patient who could benefit from behavioral health intervention. The patient is referred to Larson, who conducts a diagnostic assessment using tools such as the PHQ-9. Then, Larson and the patient determine a mutually agreeable treatment plan. When medication is prescribed, Larson continues to be involved. Once the patient is stabilized, he or she goes back to the primary care physician or may be encouraged to participate in McGregor’s wellness program. If the patient’s condition requires treatment by a psychiatrist, Larson and the primary care physician will make that connection.

Larson longs for the ability to incorporate text messaging into the clinic’s electronic medical record (EMR) to streamline the follow-up with these patients. “People need that daily connection,” she said. “Today, nurses check back with the patient in person or by phone, but text messaging would be more convenient. We just need to make sure that it is secure and part of the patient’s medical record.”

“As we move toward enhanced care coordination for chronic disease, measurement tools will be built into the EMR to generate quantitative data,” said Larson. “But anecdotal evidence is also powerful. For example, one woman just received dentures. She has a history of abuse and until now never wanted to look good. This was a huge success for her and a good example of how we measure achievements in small steps so our patients always feel successful.”

“Treating behavioral health in a primary care setting is essential,” said Larson. “We have the opportunity to affect outcomes. When people are mentally healthy, they are more likely to be physically healthy.”

“Organizations need to acknowledge the tremendous value their primary care providers bring, leveraging those resources in an integrated, team-based fashion to meet the unique needs of those they serve,” added Cooper. “We need people like Janet, who bring a passion to the topic of mental health to help lead the necessary change in the way we provide care.”