Construction had just been completed on the Ezekiel W. Cullen Building on the University of Houston campus when, in 1950, psychology professor Richard Evans joined the faculty. He’d just completed his doctorate at Michigan State and was about to do very big things that are still relevant to his field and the University nearly 70 years later.
"In 1950, when Dr. Evans founded the social psychology program at UH, he was one of the first people to introduce the idea of health psychology and behavioral medicine,” said Jack Fletcher, chair of the UH department of psychology and Hugh Roy and Lillie Cranz Cullen Distinguished Professor of Psychology.
Today, the link between behavioral health and health care has never been greater, due in part to pioneering work that began at UH in the 1950s, although integrating the two remains a challenge.
"Today, we have a much more integrated view about how the behavioral sciences fit in health care in general … a greater recognition that chronic health conditions like diabetes, obesity have a big behavioral health component,” said Fletcher.
Fast forward to 2018: the Health 2 building has just been completed, and big things continue to happen in the areas of mental and behavioral health and health care. The University of Houston is seeking approval to partner with a nonprofit Federally Qualified Health Center (FQHC). The partnership would establish a full-service health care facility in Health 2, on the southeastern corner of campus. The center, open to the public, would provide comprehensive primary and preventive care, including dental, mental and behavioral health services, to people of all ages, regardless of their ability to pay. UH’s plan is currently under review by the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services tasked with "improving health care to people who are geographically isolated, economically or medically vulnerable.”
"Partnering with a FQHC will allow the health center to qualify for federal reimbursements from Medicare and Medicaid and charge on a sliding scale for patients without insurance,” said Dr. Stephen J. Spann, vice president for medical affairs and founding dean of the UH College of Medicine. The partnership would allow us to offer care to more people, including people without any (insurance) coverage.”
UH’s vision is a primary care clinic that will provide much needed medical services to Houston’s underserved populations while training UH students studying health-related fields in the latest protocols and therapeutic, research-based treatments. In addition to hiring more licensed practitioners, faculty experts from the College of Liberal Arts and Social Sciences Department of Psychology, College of Education Department of Psychological, Health & Learning Sciences, and the Graduate College of Social Work (GCSW) would provide behavioral health services.
"It will be one-stop shopping. Patients could come in and get their physician and behavioral health needs met in a seamless fashion, which ultimately leads to better health,” said Luis Torres, GCSW associate dean of research and strategic partnerships.
We’ve come a long way since 1950 when professor Evans took psychology to the mainstream. The relationship between behavioral health and health care is now well established, but integration between the two in the primary care setting has been slow.
"At an international level, as much as 50 percent of patients seen in a primary care setting have a mental health problem as their fundamental issue,” said Spann. "Well-trained primary care clinicians recognize that. In an ideal setting, they’d make a diagnosis, prescribe medication, if necessary, and immediately walk them over to a counselor in the same practice who can see them immediately, a so-called ‘warm handoff’ model of integrated behavioral health care in a primary care setting.”
The traditional model of referrals to counseling requires the patient to seek additional treatment on their own. Some simply won’t go. Others are discouraged because it’s not covered by their health insurance. Experts say integration is desperately needed.
"Today we have a much more integrated view about how the behavioral sciences fit in health care in general … a greater recognition that chronic health conditions like diabetes, obesity have a big behavioral health component."
Texas consistently ranks at or near the bottom for access to primary care and mental health services, despite a growing need. There is a shortage of mental health and other health professionals. The UH department of psychology, for example, receives more than 500 applications for just 12 spots in its Ph.D. program every year as graduate students vie to learn under the department’s world-class faculty and researchers. But the department’s clinics were developed for training students and are able to treat a relatively small group of patients.
"We have never advertised our clinics, because we don’t have the resources to do it. A partnership with a FQHC would allow us to appoint full-time clinicians to provide services to have a bigger flow of patients,” said Fletcher.
It also creates an opportunity for medical, nursing, social work, pharmacy, clinical psychology, optometry, even law students to observe a new kind of care. It is this type of integrated care approach, leveraging the University’s vast existing health related disciplines, that will serve as the foundation of the new UH College of Medicine.
"We would use this as a teaching opportunity, a place for students to observe and participate in this kind of care under supervision of trained, licensed practitioners,” said Spann.
Will these students be ultimately working in a more integrated world? "We hope so,” he says.