"More tools in Physicians' Toolbox"

Credit: By David Kronke | Tribune-Star - Jan 31, 2023

Union Hospital has been awarded a $2.25 million grant that will improve training of medical doctors in dealing with mental and behavioral health issues.

The grant, from the Federal Bureau of Health Workforce at the Health Resources and Services Administration, was one of about 25 issued throughout the country and the only one in Indiana.

“It was pretty competitive, and I’m just grateful that we got it,” said Dr. Amber Cadick, Behavioral Health Coordinator of Union Hospital’s Family Medicine Residency.

“One reason we did get it is that our community has such extreme need,” she added, “and so the federal government saw that we needed a little extra attention here.”

The Primary Care Training and Enhancement — Residency Training in Mental and Behavioral Health — also known as PCTE-RTMB — program will train physicians in the prevention, diagnosis and treatment for mental and behavioral health conditions for those at-risk or who have experienced abuse, trauma or mental health and/or substance use disorders.

Cadick said Vigo County has a dire need for therapists with mental health expertise, as at least a third of local patients experience mental health issues, a statistic she imagines being closer to two-thirds.

“That is one reason we’re trying to give doctors more tools in their toolbox with mental health,” she said. The grant will enable Union Hospital and its partners to send physicians to specialized pediatric psychiatry training and conferences on mental health, as well as bring in guest speakers and experts to inform them on issues in the behavioral health field.

This represents part of a trend in which general practitioners are increasingly taking all aspects of one’s wellbeing into account.

“They’re treating the whole person,” Cadick said. “We have to get past this system where we divide people into body parts. We know that mental health affects our physical health, it affects our GI (gastrointestinal) system, our pain levels, all that, so it makes sense that we have primary care physicians to screen for it and have the tools for it.”

For example, there is a test for Adverse Childhood Events that asks patients about 10 traumatic occurrences they experienced before the age of 18, such as having parents or close relatives who were physically, verbally or sexually abusive, parents who were substance abuse addicts or went to prison. If the patient answers “yes” to four or more ACE questions, the risk of their getting cancer or heart disease dramatically increases.

In a 2018 survey, 25% of Vigo County patients answered yes to at least four ACEs.

“My hope is that we’ll give physicians some tools that they can use in the office setting to change the trajectory of the snowball effect,” Cadick said.

Cadick noted that 90% of psychiatry medicines are prescribed by general care doctors.

“My docs manage people with bipolar and schizophrenia, too,” she said. “Our physicians are thinking about how medications are going to interact with other meds.”

And since antidepressants in particular work with different levels of reliability for a variety of people, genetic testing with a cheek swab is available that can determine what antidepressants will work better for each person.

Union Hospital has partnered on this project with Team of Mercy, Valley Professionals, Chances for Youth and Services, United Way of the Wabash Valley, Covered Bridge Special Education District, Sarah Scott Middle School, Mental Health America, Harsha Behavioral Health, Alliance Community Training, the Vigo County Minority Health Coalition, CODA and the Juvenile Justice Center.