Mental Health Care Delivery In Austin Is Getting A Shake-Up

Dec 20, 2017

How people get mental health care is being reimagined in Austin.

Dell Medical School and several mental health providers are working together to figure out a better way to decide who gets what kind of care and who is going to give it to them.

A good example of this redesign is the bipolar disorder clinic run by Dell Medical School and Integral Care, Travis County’s mental health agency.

The director, Dr. Jorge Almeida, says the clinic is centered around patients. For example, the design puts a premium on privacy. In fact, you won’t see patients sitting in a waiting room, because there is no waiting room.

“[Patients] meet the concierge staff at the front desk,” he says. “And the concierge brings them to their care room where they will be for the entire time of their visit with us.”

There are about 10 care rooms, which look like living rooms, at the clinic.
Credit Jorge Sanhueza-Lyon / KUT

Almeida slides open a big yellow door to reveal what looks like a living room in an apartment. There’s a couch, chairs and a TV. Almeida says the medical staff patients need will come to them.

“The design is very unique that we have two doors,” Almeida says, “one for the patient to enter and the other one for the providers to enter.”

There are about 10 of these rooms in the clinic, where half the staff is hired by Dell Medical School and the other half is hired by Integral Care.

Robert Dominguez, the practice administrator for clinic operations with Integral Care, says this is good for providers because they have a space to try new things.

“This really allows us this opportunity to meld together the practical side of providing services – which Integral Care has been doing for the past 50 years,” he says, “and the UT medical school who is really allowing us to be a part of this innovative care.”

Having researchers, students and care providers working side by side has mutual benefit, says Kathleen Casey, a director at Integral Care.

“It typically takes well over a decade to translate experimental research findings – sort of best practices that are discovered through science,” she says. “It takes about 10 years or more to translate that into actual community practice.”

Casey says with this partnership that process is accelerated. For Dell Med, this is a win, too. It gets to send its medical students to work in real-world settings at Integral Care clinics around the city.

Different Care At Different Levels

This is all part of a larger effort to redesign mental health care in Austin – and throughout Texas.

Steve Strakowski, chairman of psychiatry at Dell Medical School, says one change Austinites will start noticing is that mental health care won’t just be in hospitals.

“That’s been part of the problem we’ve had,” he says. “When you have a hospital-centric high-illness – you know a very sick person – as your primary focus, you end up treating everybody like they're the same thing, and it just costs more and it also fails to provide the care you need at different levels.”

Strakowski says most patients just need prescription refills and a quick check-in – and they don’t always need a doctor for that. He says Dell needs to train more people to do this work, though.

“There’s often an idea, ‘Well, we need to try to get all medical students to basically go into psychiatry,’” Strakowski says, “but that’s obviously never going to happen. And so we have to use the best approaches we can to expand our workforce and then use the workforce as effectively as possible.”

He says that means getting social workers, nurses and other folks to pitch in. And that’s something Dell Med is working on, too.

A Model For Others

All these changes are going to be revisited and perfected and replicated in the coming years. Eventually, Strakowski says, some of the changes will be part of the redesign of the Austin State Hospital.

More importantly, though, he says, this is an opportunity for Texas.

“Typically, mental health care delivery has been better in the coasts and the Northeast, and it'd be nice for Texas to kind of change that pattern and step up and be a leader,” he says. “That’s our goal.”