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Journal of Clinical Psychology in Medical Settings

, Volume 20, Issue 3, pp 294–301 | Cite as

Integrating Mental Health Services into a General Hospital in Puerto Rico

  • J. Jiménez
  • D. Rivera
  • P. Benítez
  • H. Tarrats
  • A. Ramos
Article
  • 243 Downloads

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.

Keywords

Clinical Psychology Hospital Integrated Medical setting 

Notes

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.

References

  1. 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
  2. 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.PubMedCrossRefGoogle Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorder (revised 4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  4. 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.CrossRefGoogle Scholar
  5. 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
  6. 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.PubMedCrossRefGoogle Scholar
  7. 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
  8. 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.PubMedCrossRefGoogle Scholar
  9. 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.CrossRefGoogle Scholar
  10. 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.CrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. Cuijpers, P., Brännmark, J. G., & van Straten, A. (2008). Psychological treatment of postpartum depression: A meta-analysis. Journal of Clinical Psychology, 64, 103–118.PubMedCrossRefGoogle Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. 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.Google Scholar
  16. 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.
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. Dunn, R. (1986). General hospital psychology. Canadian Psychology, 27, 44–50.CrossRefGoogle Scholar
  20. Egede, L. (2004). Diabetes, major depression, and functional disability among adults. Diabetes Care, 27, 421–428.PubMedCrossRefGoogle Scholar
  21. Follette, W., & Cummings, N. (1967). Psychiatric services and medical utilization in a prepaid health plan setting. Medical Care, 5, 25–35.CrossRefGoogle Scholar
  22. Gatchel, R. (2004). Comorbidity of chronic pain and mental health disorders: The biopsychosocial perspective. American Psychologist, 59, 795–805.PubMedCrossRefGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 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
  25. Goodheart, C. (2011). Psychology practice: Design for tomorrow. American Psychologist, 66, 339–347.PubMedCrossRefGoogle Scholar
  26. 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
  27. 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.Google Scholar
  28. Hunsley, J. (2002). The cost-effectiveness of psychological interventions. Ottawa, ON: Canadian Psychological Association.Google Scholar
  29. Hunsley, J. (2003). Cost-effectiveness and medical cost-offset considerations in psychological service provision. Canadian Psychology, 44, 61–73.CrossRefGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. Kaplan, R., & Groessl, E. (2002). Applications of cost-effectiveness methodologies in behavioral medicine. Journal of Consulting and Clinical Psychology, 70, 482–493.PubMedCrossRefGoogle Scholar
  33. 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.CrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 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.CrossRefGoogle Scholar
  36. Levant, R., House, A., May, S., & Smith, L. (2006). Cost offset: Past, present, and future. Psychological Services, 3, 195–207.CrossRefGoogle Scholar
  37. Levitan, S., & Kornfeld, D. (1981). Clinical and cost benefits of liaison psychiatry. The American Journal of Psychiatry, 139, 790–793.Google Scholar
  38. Lipowski, Z. J. (1988). Somatization: The concept and its clinical application. The American Journal of Psychiatry, 145, 1358–1368.PubMedGoogle Scholar
  39. Mehl-Madrona, L. (2008). Prevalence of psychiatric diagnosis among frequent users of rural emergency medical services. Canadian Journal of Rural Medicine, 13, 22–30.PubMedGoogle Scholar
  40. 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.CrossRefGoogle Scholar
  41. 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).Google Scholar
  42. Newman, R., & Rozensky, R. H. (1995). Psychology and primary care: Evolving traditions. Journal of Clinical Psychology in Medical Settings, 2, 3–6.CrossRefGoogle Scholar
  43. Nimnuan, C., Hotof, M., & Wessley, S. (2001). Medically unexplained symptoms: An epidemiological study in seven specialities. Journal of Psychosomatic Research, 51, 361–367.PubMedCrossRefGoogle Scholar
  44. 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.PubMedCrossRefGoogle Scholar
  45. 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.PubMedCrossRefGoogle Scholar
  46. Robinson, J., & Baker, J. (2006). Psychological consultation and services in a general medical hospital. Professional Psychology: Research and Practice, 37, 264–267.CrossRefGoogle Scholar
  47. 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.PubMedCrossRefGoogle Scholar
  48. Seltzer, A. (1989). Prevalence, detection and referral of psychiatric morbidity in general medical patients. Journal of the Royal Society Medicine, 82, 410–412.Google Scholar
  49. 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.PubMedCrossRefGoogle Scholar
  50. 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
  51. 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.PubMedGoogle Scholar
  52. 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.PubMedCrossRefGoogle Scholar
  53. Smith, G. (2002). The future of consultation–liaison psychiatry. Australian and New Zealand Journal of Psychiatry, 37, 150–159.CrossRefGoogle Scholar
  54. 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.PubMedCrossRefGoogle Scholar
  55. U.S. Census Bureau. (2000). Puerto Rico Census. Washington, D.C. Retrieved from http://www.census.gov.
  56. Welch, C., Czerwinski, D., Ghimire, B., & Bertsimas, D. (2009). Depression and cost of health care. Psychosomatic, 50, 392–401.CrossRefGoogle Scholar
  57. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • J. Jiménez
    • 1
  • D. Rivera
    • 2
  • P. Benítez
    • 2
  • H. Tarrats
    • 2
  • A. Ramos
    • 1
  1. 1.Clinical Psychology DepartmentPonce School of Medicine and Health SciencesPonceUSA
  2. 2.Department of MedicineDamas HospitalPRUSA

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