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Integrating Mental Health Services into a General Hospital in Puerto Rico

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Abstract

The prevalence of mental health problems in the general population should be carefully considered. The literature has reported a high co-morbidity of medical and mental illnesses; therefore, collaborative efforts incorporating psychological services into medical settings are imperative. In Puerto Rico, this is not a regular practice in general hospitals. Improving access to mental health services is a challenge and requires the creation of new venues within the healthcare system. This paper describes the theoretical framework, mission, and objectives of the Clinical Psychology Services Program (CPSP) implemented at Damas Hospital in Puerto Rico. From December 2002 to December 2010, a total of 13,580 visits were made to inpatients in diverse clinical units of the hospital; 61 % of all inpatients evaluated met the criteria for at least one mental health disorder based on the DSM-IV-TR. The CPSP’s outcomes highlight the acceptance and relevance of incorporating mental health services and clinical psychologists into general hospitals.

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References

  • Alegria, M., Canino, G., Shrout, P., Woo, M., Duan, N., Vila D.,…,Meng, X. (2008). Prevalence of mental health illness in immigrant and non-immigrant U.S. Latino groups. American Journal of Psychiatry, 165, 359–369.

    Google Scholar 

  • Alegría, M., Mulvaney-Day, N., Torres, M., Polo, A., Cao, Z., & Canino, G. (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97, 68–75.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorder (revised 4th ed.). Washington, DC: American Psychiatric Association.

  • Antonuccio, D., Thomas, M., & Danton, W. (1997). A cost-effectiveness analysis of cognitive behavior therapy and Fluoxetine (Prozac) in treatment of depression. Behavior Therapy, 28, 187–210.

    Article  Google Scholar 

  • Baca-García, E., Pérez, M., Basurte, I., Quintero, F., Sevilla, J., Martínez,…,González, J. (2008). Patterns of mental health service utilization in a general hospital and outpatient mental facilities: Analysis of 365,262 psychiatric consultations. European Archives of Psychiatry and Clinical Neuroscience, 258(2), 117–123.

    Google Scholar 

  • Bourgeois, J., Kremen, W., Servis, M., Wegelin, J., & Hales, R. (2005). The impact of psychiatric diagnosis on length of stay in a university medical center in the manage care era. Psychosomatics, 46, 431–439.

    Article  PubMed  Google Scholar 

  • Canino, G., Bird, H., Rubio-Stipec, M., & Bravo, M. (2000). The epidemiology of mental health disorders in the adults population of Puerto Rico. Interamerican Journal of Psychology, 34, 29–46.

    Google Scholar 

  • Canino, G., Bird, H., Rubio-Stipec, M., Bravo, M., Martínez, R., Sessman, M., et al. (1987). The prevalence of specific psychiatric disorders in Puerto Rico. Archives of General Psychiatry, 44, 727–735.

    Article  PubMed  CAS  Google Scholar 

  • Chiles, J., Lambert, M., & Hatch, A. (1999). The impact of psychological interventions on medical cost-offset: A meta-analytic review. Clinical Psychology: Science and Practice, 6, 201–219.

    Article  Google Scholar 

  • Ciechanowski, P., Katon, W., & Russo, J. (2000). Depression and diabetes: Impact of depressive symptoms on adherence, function, and costs. Archive of Internal Medicine, 160, 3278–3285.

    Article  CAS  Google Scholar 

  • Clarke, D., Dusome, D., & Hughes, L. (2007). Emergency department from the mental health client’s perspective. International Journal of Mental Health Nursing, 16, 126–131.

    Article  PubMed  Google Scholar 

  • Crane, D., & Christenson, J. (2008). The medical offset effect: Patterns in outpatient services reduction for high utilizers of health care. Contemporary Family Therapy, 30, 127–138.

    Article  Google Scholar 

  • Cuijpers, P., Brännmark, J. G., & van Straten, A. (2008). Psychological treatment of postpartum depression: A meta-analysis. Journal of Clinical Psychology, 64, 103–118.

    Article  PubMed  Google Scholar 

  • Davidson, K., Mostofsky, E., Gidron, Y., & Trudeau, K. (2007). Hospitalization cost offset of a hostility intervention for coronary heart disease patient. Journal of Consulting and Clinical Psychology, 75, 657–662.

    Article  PubMed  Google Scholar 

  • Departamento de Salud del Estado Libre Asociado de Puerto Rico. (2004). Estadísticas vitales de Puerto Rico, 1990, 1991, 1992, 1993, 1994, 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2002 [Vital statistics for Puerto Rico, 1990, 1991, 1992, 1993, 1994, 1995, 1996, 1997, 1998, 1999, 2000, 2001, 2002]. Secretaría Auxiliar de Planificación, Evaluación Estadística y Sistemas de Información. San Juan, Puerto Rico: Departamento de Salud.

  • Departamento de Salud del Estado Libre Asociado de Puerto Rico. (2004). Análisis del sector de salud [Analysis for the health sector]. San Juan, Puerto Rico: Departamento de Salud de Puerto Rico. Retrieved from http://tendenciaspr.uprrp.edu/salud/informe_salud/Analisis_sectorial_PR_final.doc.

  • DeRubeis, R. J., & Crits-Christoph, P. (1998). Empirically supported individual and group psychological treatments for adult mental disorders. Journal of Consulting and Clinical Psychology, 66, 37–52.

    Article  PubMed  CAS  Google Scholar 

  • Druss, B., Rosenheck, R., & Sledge, W. (2000). Health and disability costs of depressive illness in a major U.S. corporation. The American Journal of Psychiatry, 157, 1274–1278.

    Article  PubMed  CAS  Google Scholar 

  • Dunn, R. (1986). General hospital psychology. Canadian Psychology, 27, 44–50.

    Article  Google Scholar 

  • Egede, L. (2004). Diabetes, major depression, and functional disability among adults. Diabetes Care, 27, 421–428.

    Article  PubMed  Google Scholar 

  • Follette, W., & Cummings, N. (1967). Psychiatric services and medical utilization in a prepaid health plan setting. Medical Care, 5, 25–35.

    Article  Google Scholar 

  • Gatchel, R. (2004). Comorbidity of chronic pain and mental health disorders: The biopsychosocial perspective. American Psychologist, 59, 795–805.

    Article  PubMed  Google Scholar 

  • Geist, R. (1995). Psychosocial care in the pediatric hospital: The need for scientific validation of clinical and cost effectiveness. General Hospital Psychiatry, 17, 228–234.

    Article  PubMed  CAS  Google Scholar 

  • Gonick, U., Farrow, I., Meier, M., Ostmand, G., & Frolick, L. (1981). Cost effectiveness of behavioral medicine procedures in the treatment of stress-related disorders. American Journal of Clinical Biofeedback, 4, 16–24.

    Google Scholar 

  • Goodheart, C. (2011). Psychology practice: Design for tomorrow. American Psychologist, 66, 339–347.

    Article  PubMed  Google Scholar 

  • Hämäläinen, J., Isometsa, E., Laukkala, T., Kapiro, J., Poikolainen, K., Heikkinen,…,Aro, H. (2004). Use of health services for major depressive episode in Finland. Journal of Affective Disorders, 79, 105–112.

    Google Scholar 

  • Heidenreich, P., Trogdon, J., Khavjou, O., Butler, J., Dracup, K., Ezekowitz, M.,…,Woo, Y. J. (2011). Forecasting the future of cardiovascular disease in the United States: A policy statement from the American Heart Association. Circulation, 123, 933–944.

  • Hunsley, J. (2002). The cost-effectiveness of psychological interventions. Ottawa, ON: Canadian Psychological Association.

    Google Scholar 

  • Hunsley, J. (2003). Cost-effectiveness and medical cost-offset considerations in psychological service provision. Canadian Psychology, 44, 61–73.

    Article  Google Scholar 

  • Junghan, U., & Brenner, H. (2006). Heavy use of acute in-patient psychiatric services: The challenge to translate a utilization pattern into service provision. Acta Psychiatrica Scandinavica, 113, 24–32.

    Article  Google Scholar 

  • Kalucy, R., Thomas, L., & King, D. (2005). Changing demand for mental health services in the emergency department of a public hospital. Australian and New Zealand Journal of Psychiatry, 39, 74–80.

    Article  PubMed  Google Scholar 

  • Kaplan, R., & Groessl, E. (2002). Applications of cost-effectiveness methodologies in behavioral medicine. Journal of Consulting and Clinical Psychology, 70, 482–493.

    Article  PubMed  Google Scholar 

  • Kashner, T. M., Suppes, T., Rush, A. J., & Altshuler, K. Z. (1999). Measuring use of outpatient care among mentally ill individuals: A comparison of self-reports and provider records. Evaluation and Program Planning, 22, 31–40.

    Article  Google Scholar 

  • Kent, S., & Yellowless, P. (1995). The relationship between social factors and frequent use of psychiatric services. Australian and New Zealand Journal of Psychiatry, 29, 403–408.

    Article  PubMed  CAS  Google Scholar 

  • Kraft, S., Puschner, B., Lambert, M., & Kordy, H. (2006). Medical utilization and treatment outcome in mid- and long-term outpatient psychotherapy. Psychotherapy Research, 16, 241–249.

    Article  Google Scholar 

  • Levant, R., House, A., May, S., & Smith, L. (2006). Cost offset: Past, present, and future. Psychological Services, 3, 195–207.

    Article  Google Scholar 

  • Levitan, S., & Kornfeld, D. (1981). Clinical and cost benefits of liaison psychiatry. The American Journal of Psychiatry, 139, 790–793.

    Google Scholar 

  • Lipowski, Z. J. (1988). Somatization: The concept and its clinical application. The American Journal of Psychiatry, 145, 1358–1368.

    PubMed  CAS  Google Scholar 

  • Mehl-Madrona, L. (2008). Prevalence of psychiatric diagnosis among frequent users of rural emergency medical services. Canadian Journal of Rural Medicine, 13, 22–30.

    PubMed  Google Scholar 

  • Murray, C., & Lopez, A. (1997). Alternative projections of mortality and disability by cause 1990–2020: Global burden of disease study. The Lancet, 349, 1498–1504.

    Article  CAS  Google Scholar 

  • National Alliance on Mental Illness. (July, 2004). Cumbre Multisectorial de Salud Mental, Puerto Rico 2004 [Multisector Mental Health Summit]. San Juan, Puerto Rico: National Alliance on Mental Illness (NAMI-PR).

  • Newman, R., & Rozensky, R. H. (1995). Psychology and primary care: Evolving traditions. Journal of Clinical Psychology in Medical Settings, 2, 3–6.

    Article  Google Scholar 

  • Nimnuan, C., Hotof, M., & Wessley, S. (2001). Medically unexplained symptoms: An epidemiological study in seven specialities. Journal of Psychosomatic Research, 51, 361–367.

    Article  PubMed  CAS  Google Scholar 

  • Ortega, A., Feldman, J., Canino, G., Steinman, K., & Alegría, M. (2006). Co-occurrence of mental and physical illness in US Latinos. Social Psychiatry and Psychiatric Epidemiology, 41, 927–934.

    Article  PubMed  Google Scholar 

  • Pyne, J., Rost, L., Zhang, M., Williams, D., Smith, J., & Fortner, J. (2003). Cost-effectiveness of a primary care depression intervention. Journal of General Internal Medicine, 18, 432–441.

    Article  PubMed  Google Scholar 

  • Robinson, J., & Baker, J. (2006). Psychological consultation and services in a general medical hospital. Professional Psychology: Research and Practice, 37, 264–267.

    Article  Google Scholar 

  • Schlesinger, H., Mumford, E., Glass, G. V., Patrick, C., & Sharfstein, S. (1983). Mental health treatment and medical care utilization in a fee-for-service system: Outpatient mental health treatment following the onset of a chronic disease. American Journal of Public Health, 73, 422–429.

    Article  PubMed  CAS  Google Scholar 

  • Seltzer, A. (1989). Prevalence, detection and referral of psychiatric morbidity in general medical patients. Journal of the Royal Society Medicine, 82, 410–412.

    CAS  Google Scholar 

  • Shaw, J., Sicree, R., & Zimmet, P. (2010). Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice, 87, 4–14.

    Article  PubMed  CAS  Google Scholar 

  • Simon, G., Katon, W., Lin, E., Rutter, C., Manning, W., Von Korff, M.,…,Young, B. (2007). Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Archives of Geneneral Psychiatry, 64, 65–72.

    Google Scholar 

  • Simon, G., Ormel, J., Von Korff, M., & Barlow, W. (1995). Health care costs associated with depressive and anxiety disorders in primary care. The American Journal of Psychiatry, 152, 352–357.

    PubMed  CAS  Google Scholar 

  • Simpson, J., SA, Carlson, L. E., & Trew, M. E. (2001). Effect of group therapy for breast cancer on healthcare utilization. Cancer Practice, 9, 19–26.

    Article  PubMed  CAS  Google Scholar 

  • Smith, G. (2002). The future of consultation–liaison psychiatry. Australian and New Zealand Journal of Psychiatry, 37, 150–159.

    Article  Google Scholar 

  • Smith, G. (2009). From consultation–liaison psychiatry to integrated care for multiple and complex needs. Australian and New Zealand Journal of Psychiatry, 43, 1–12.

    Article  PubMed  CAS  Google Scholar 

  • U.S. Census Bureau. (2000). Puerto Rico Census. Washington, D.C. Retrieved from http://www.census.gov.

  • Welch, C., Czerwinski, D., Ghimire, B., & Bertsimas, D. (2009). Depression and cost of health care. Psychosomatic, 50, 392–401.

    Article  Google Scholar 

  • Welton, K., Caldwell, D. M., Adamapoulos, E., & Vedhara, K. (2009). Mixed treatment comparison meta-analysis of complex interventions: Psychological interventions in coronary heart disease. American Journal of Epidemiology, 169, 1158–1165.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank doctoral students of the Clinical Psychology Program of the Ponce School of Medicine for their enthusiastic support and participation during these eight years. Also, thanks to the administrative staff and health care providers, especially physicians and nurses of the Damas Hospital at Ponce, Puerto Rico. Our special thanks to Dr. Javier Hernández, Dr. Nanet López, Dr. Mary Rodríguez, and Dr. Nydia Ortiz for your valuable support as clinical supervisors during the different stages of the Clinical Psychology Services Program development. Also, a special thanks to Mr. Bob Richie for assisting in the manuscript’s edition.

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Correspondence to J. Jiménez.

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Homero Tarrats is deceased.

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Jiménez, J., Rivera, D., Benítez, P. et al. Integrating Mental Health Services into a General Hospital in Puerto Rico. J Clin Psychol Med Settings 20, 294–301 (2013). https://doi.org/10.1007/s10880-012-9352-x

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