For historically underserved populations, stigma and lack of access to behavioral health services can present huge barriers to treatment.  In this conversation, Matthew Hoag, director of integrated behavioral health at Denver Health, shares how the organization is innovating through integration to meet the behavioral health needs of its communities, including with its state-of-the-art mobile opioid treatment unit.

Tom Haederle

Often, people with severe mental illness lead shorter lives, sometimes up to 25 years less. For historically underserved populations and minorities, this can be compounded. A recent Kaiser Family Foundation report found that rates of death by suicide are rising faster among black, Hispanic, and other people of color than whites. There are many reasons for this, including access to care, stigma, and even implicit bias in the health care system itself.

Tom Haederle

There isn't one magic solution to all of these problems, but as Denver Health has found out, the integrated care system goes a long way towards reducing health disparities and providing the care that patients need and deserve.

Tom Haederle

Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. In this podcast, hosted by Rebecca Chickey, senior director of Behavioral Health Services with AHA, we learn how Denver Health's commitment to integration as a tool for increasing access to behavioral health has benefited the communities it serves by reducing stigma and health disparities.

Tom Haederle

As Matthew Hoag, director of Integrated Behavioral Health for Denver Health, says, a patient can now discretely get all of their health conditions addressed in one place. And that's incredible. Here's Rebecca.

Rebecca Chickey

It is my honor indeed to be here with Matthew Hoag from Denver Health. He has so much experience in the value of integrating physical and behavioral health. And it's an honor for myself and our listeners today to be able to listen and learn from him. Today, we're really going to focus on the value of integrating physical and behavioral health in terms of how it can help reduce health disparities for historically underserved communities, individuals, and communities of color, as well as those individuals who suffer from severe and persistent mental illness, such as schizophrenia and bipolar disorder.

Rebecca Chickey

The reason that these things are so important is what Matthew's going to share with us. But I want to put in just a couple of thoughts. One, when you hear what he says about the importance of integration and the value that that delivers for individuals with severe and persistent mental illness, one of the really important things is that is what people often refer to as bi-directional integration, meaning individuals with severe mental illness often die 17 to 25 years earlier than those individuals without. And that's not due to suicide. That is due to their inability because of poor management in many cases of their mental illness.

Rebecca Chickey

And then health disparities exist across the board for communities of color. And when you begin to look at it through the lens of behavioral health care, unfortunately, the magnitude of those disparities often goes up. So with that as general background, Matthew, can you tell me just a little bit about the realities - as I started talking about - and the vulnerabilities around mental health disparities, and what are those challenges that those individuals face?

Matthew Hoag

Thank you. Rebecca. Before we start, too, I just want to acknowledge my privilege as a as a white male. And just hammer home that I choose to work in a community health center here at our Denver health hospital because I believe in our organization's mission to provide all in our community access to the highest quality and equitable health care, regardless of the patient's background or ability to pay

Matthew Hoag

so really appreciate the opportunity to talk on these topics. You know, what we know is that an estimated 43% of people with mental health concerns are connected to care, and that's a pretty alarming statistic. Some of the realities and challenges for individuals of color, include implicit bias, which comes up quite a bit in how patients might be identified or selected for referrals to behavioral health or identified or even properly diagnosed.

Matthew Hoag

And so this this plays a huge impact for individuals of color. The other thing that's kind of difficult within behavioral health is it can be very difficult to navigate our complex health system, but even more specifically, our sometimes complex behavioral health system, because it can be difficult to know what somebody feels like they need to be connected to.

Matthew Hoag

And so if there isn't really good screening, really good assessments, sometimes individuals and families are at a loss of where to go or where to start, or who even to ask to begin that journey. I think another area that we see, and that we're trying really hard as an organization to impact, is a lack of diversity among our care teams.

Matthew Hoag

We, at Denver Health have community health centers. And what I love about Denver Health is these community health centers are situated in very historic neighborhoods within Denver County, we're I think the fifth largest federally qualified health system in the country. We strive to have those clinics be a reflection of those communities they serve. Really requires us to have staff as a reflection of those patients.

Matthew Hoag

Why that's important is because trust. Trust is incredibly important with the care team to be able to break down some of these racial disparities. Now, where does integrated behavioral health come in with this? I could talk about integrated behavioral health all day. We have really good research that shows that improves patient outcomes, reduce total cost of care, increase access above all to behavioral health.

Matthew Hoag

And we also see that patients like what is incredibly valuable to me is that when I have a medical provider pull me in to consult with a patient for a behavioral health concern, sometimes that patient has been coming to that clinic for ten, 15 years. Their parents had gone there. Their parents still go there for care. Their kids get their vaccinations, get wellness exams there.

Matthew Hoag

And so when I come into the room, I have this unparalleled level of support and trust already because that medical provider who has that trust with that patient says, this is Matt. He's an expert in X, Y, and Z depression, whatever substance treatment. And he wants to come talk with you to see how we can support that goal or support.

Matthew Hoag

You know, let's talk a little bit more about, you know, what's going on over here. And that's the value of integrated care.

Rebecca Chickey

You have talked about the importance of trust. The fact that it's real time, meaning you can call in a medical provider or you can be called in as the expert to help that patient real time. Is that something that you see has also been beneficial in terms of reducing the stigma, because you've used the term trust a couple of times, but often we hear the horrible word, the big thing in the room, the stigma of even seeking or talking about mental health treatment or my anxiety or panic attack.

Rebecca Chickey

Is that another aspect of this?

Matthew Hoag

Absolutely. Stigma, I'm glad you brought that up. Stigma is all about what we're trying to reduce and what our integrated behavioral health can be really substantial. Early on in my career with integrated behavioral health, I specialized within substance treatment and co-occurring as well with other behavioral conditions. But one thing I always when I walked into the room, as I always try to keep in the focus, that it is very likely that the individual that I'm about to meet has had a negative interaction or has been judged for a behavioral health or substance treatment condition at some point prior to meeting me.

Matthew Hoag

And so I try to think about how I approach that from a culturally sensitive way, but also identify and create some safety where I can. I'm very fortunate to have that collaborative medical team to help with that trust, but it's something that we have to be very, very cognizant about because it is a reality that's in the room.

Rebecca Chickey

It's so very important because stigma exists for all of us, regardless of your ethnicity, the location or culture that you've been brought up in, your skin color. But unfortunately for many, many different cultures and even genders, we still see the statistics show that women are more likely to ask for help than men, regardless of everything else.

Rebecca Chickey

And then within certain cultures that stigma is at a much higher bar. So it's just uplifting and hopeful that, integration can address those in a way that is seamless in many ways.

Matthew Hoag

Absolutely. And I think what folds into the trust piece is the cultural competency of our staff. And so, you know, our organization and our integrated behavioral team places part of our values as a team is around diversity, equity and inclusiveness and belonging and how that shows up in our clinical practice, being able to identify microaggressions within teams and being able to have open discussions about how that influences us as providers, but also impacts our ability to deliver effective clinical care. Something that is also really important with this - in order to have and to recruit for diverse care teams, is we often put a lot of emphasis on recruitment, but retention is also really

Matthew Hoag

important for keeping that healthy for our teams.

Rebecca Chickey

As we begin to wrap up, are there a couple of things that you think have made Denver Health's program successful?

Matthew Hoag

I think the thing I most appreciate about where I work is the individuals I work with as well. We're a large organization, and we have done some pretty cool things that are a little out there, but we're not afraid to try that. One particular project I want to highlight is we just last year launched a mobile opioid treatment unit, and this was a collaboration between our brick and mortar opioid treatment program and our community health services.

Matthew Hoag

And so this mobile unit actually goes out to two of our qualified health centers, our eastside and westside clinic. And we do walk-ins for opioid treatment, particularly for methadone. And what's amazing about that is if, you know, you know how sometimes there's some realities and difficulties with accessing Opidone and it's, you know, very regulated, very structured.

Matthew Hoag

You usually have to go really early in the morning to receive that. We did something where we enhanced a lot of current patients care, because we have patients who go to the Eastside Health Center, then go across town to you know, their opioid treatment program. It's not quite integrated, but what I would call is it's very co-located and very collaborative.

Matthew Hoag

But a patient can discreetly now get all of their health conditions addressed in one place. And that's incredible. Especially with fentanyl opioid epidemic being able to enhance care in a way that is trauma informed as well as, kind of helping break down some of those barriers to access. I like that we get to do that.

Matthew Hoag

I'm incredibly grateful, and it feels incredibly special to be able to try to do things like that, to really enhance care for all of our patients.

Rebecca Chickey

So the key point, I think, for the listeners is to not be afraid to try. That was unusual. That's out of the box. I think sometimes when we're young, we try everything, right? Sometimes to the demise of our parents or whoever is bringing us up. But we're not afraid to try. And sometimes I think the world changes that perspective.

Rebecca Chickey

So, we need to remember. Don't be afraid to try, because you're all you're trying to do is to improve outcomes and reduce the cost of care and improve somebody's life. Thank you so much for sharing your time and your expertise with us today. Thank you for the work that you're doing across the fine mountain city of Denver.

Rebecca Chickey

And thank you for your passion for your work.

Matthew Hoag

Thanks for having me.

Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.