AF Program Increases Access to Behavioral Health Care

Nearly half of people with a treatable behavioral health disorder do not seek help from behavioral health professionals, according to the Department of Health and Human Services. However, 80 percent of this population does visit a primary care manager at least once a year. An Air Force program seeks to bridge this gap by providing behavioral health care in a primary care setting. 

The Behavioral Health Optimization Program (BHOP) integrates behavioral health personnel into primary care clinics to provide "the right care, at the right time, in the right place." Beneficiaries with behavioral health concerns can seek care directly through their primary care manager.

Issues such as compounding stress can lead to depression, post-traumatic stress disorder, or general anxiety disorders. Often times, problems resulting in adverse mental health effects can be addressed by primary care providers through the support of behavioral health services.

"We are there to address the concerns that would have otherwise been brought to the primary care manager," said Maj. Elizabeth Najera, the chief of the program, overseen by the Air Force Medical Operations Agency.

For instance, when a patient suffering severe headaches sees a primary care manager, it is determined whether the patient needs to be referred to neurology or requires additional examination from primary care. BHOP visits function in the same manner and patients are screened to help identify the right level of care.

According to Najera, only 1 out of 10 patients seen requires referral to specialty care. Mild depression, anxiety or grief may not require specialty mental health services. While specialty care is beneficial when that is the appropriate level of care, it may not be necessary for a normal process like bereavement. Even if a patient visit warrants a specialty care referral, time required for specialty care is reduced by BHOP intervention.

"BHOP is an excellent first step in seeking care if (someone has) any behavioral health concerns with either a medical or lifestyle component," Najera said. "Everyone can consider at least one BHOP encounter appropriate, while not everyone may require a second visit." 

BHOP consultations typically do not require more than four visits. A BHOP appointment lasts about 25 minutes and patients leave with some form of same-day intervention. Patients are triaged to ensure they get the appropriate resources and providers determine what level of care is needed.

BHOP helps to address a wide range of health related behaviors which can worsen medical conditions, including diabetes, chronic pain, sleep problems, and hypertension.

Another benefit of BHOP is the ease of use. Half of all scheduled visits are same-day appointments. BHOP seeks to address a large patient volume with same-day care. According to Najera, the goal is to address patient needs as they arise rather than having patients wait.

"(A BHOP visit) is considered a primary care appointment and there is no difference in how it is treated in a patient's electronic health record," Najera said.

BHOP offers two types of services and patients will either see Internal Behavioral Health Consultants (IBHCs) or Behavioral Health Care Facilitators (BHCFs). IBHCs include both psychologists and social workers who provide focused assessments and recommendations to help primary care providers with decisions about patients' behavioral health concerns. BHCFs are nurses who work directly with patients who have been prescribed psychotropic medications by their primary care provider for depression, anxiety or PTSD.

The goal of BHOP is to help patients and providers reach desired and realistic behavioral health outcomes. This includes improving quality of life or returning to a level of functioning closer to a patient's goal. Some patients may walk away learning to manage chronic conditions, while having improved day-to-day functioning.

In a 2015 survey of 631 patients, almost 90 percent reported being very or extremely satisfied with the BHOP experience and over 95 percent stated they would probably or definitely recommend BHOP to a friend or family member.

Patients who received care through BHOP were asked if they would have sought behavioral health services if BHOP had not been available. Of those surveyed, 30 percent reported they would not have sought any care if not for BHOP.

Those with behavioral health concerns are encouraged to speak to their primary care provider. BHOP emphasizes that seeking help is a sign of strength and prevention is key. For those in need of behavioral health care, seeking care could help prevent a negative life impact.

Any individuals experiencing escalated behavioral health issues including thoughts of harming themselves should go to the nearest hospital emergency room and seek help immediately.

BHOP is available at 72 of the 76 Air Force military treatment facilities. The program is open to all military beneficiaries and walk-ins are accepted. BHOP does not require a referral. To schedule a BHOP appointment, beneficiaries are advised to call the appointment line.