Strengthening the safety net: Grady brings mental health services into primary care

After her daughter’s death last year, Helen Dennard says, “I went over the edge.’’

It followed other deaths in her family in recent years. Dennard, an Atlanta resident, found herself angry and depressed by the time she went to her regular Grady Health System physician for a checkup.

“I had really given up on life. I wasn’t eating, I wasn’t sleeping,’’ says Dennard, 66. “I wouldn’t leave the house or do anything.’’

Grady Memorial Hospital

Her physician connected Dennard to a licensed clinical social worker at Grady, who began regular therapy sessions with the longtime Grady patient.

For more than a year now, Grady has blended mental health services into regular patient visits in the Atlanta system’s primary care clinics. Screening for mental health problems is now part of a patient’s regular Grady primary care visit.

Since 2017, about 80,000 patients have been screened for depression through the Grady “integrated behavioral health” program. About 3,000, like Dennard, have been referred to behavioral health care after visiting one of Grady’s eight primary care clinics. In addition to therapists, Grady has psychiatrists and a clinical pharmacist to help these patients, along with access to tele-psychiatry.

Patients with a severe mental health or substance use problem are referred to emergency or inpatient care at Grady Memorial Hospital, and officials say those with chronic schizophrenia or bipolar illness are referred to long-term treatment programs. The safety-net hospital already sees a huge number of mental health patients through its ER, with 1,000 emergency psychiatric emergency visits in June alone.

The seamless hand-off to mental health services within the Grady clinic means people feel “less stigma” about needing those services, says Gregory Sterchi, manager of the integrated care program for Grady.

The integrated approach brings people into mental health care who wouldn’t normally seek it, says LaShanda Johnson, one of the therapists Grady has for the program.

“It may be their first time’’ getting mental health services, says Johnson, a licensed clinical social worker. “They may have been depressed for a long time and didn’t know it.”

Helen Dennard (left) meets with LaShanda Johnson.

Primary care settings, like a doctor’s office, already provide about half of all mental health care for common psychiatric disorders, according to the National Institute on Mental Health.

Studies have shown that integrating behavioral health into primary care can lead to better health outcomes for patients – and lower overall health costs.

Dr. Kelley Carroll, vice president of ambulatory services for Grady, had experience with integrated health in Texas before coming to Atlanta. Carroll says 25 percent of all primary care patients have underlying mental health issues, such as mild depression or anxiety.

“The patients may not bring it up’’ during their regular primary care visit, Carroll says. “They may come in with diabetes or stomach problems.”

Day-to-day stresses such as poverty and food insecurity can play a role in mental health challenges, she adds.

Anxiety can worsen illness

An increasing number of primary care practices in the United States now have a licensed health psychologist on staff, WebMD reported recently.

Dr. Shelley Nuss, dean at the Augusta University/University of Georgia Medical Partnership, says the Grady integrated program “is a great thing.’’


“It’s one-stop shopping for the patient,’’ Nuss says, adding that many patients don’t realize that their physical symptoms may be linked to undiagnosed mental health issues.

“I think there’s more stigma for a person [going to] a psychiatrist’s office,’’ says Nuss, who is trained as both an internist and a psychiatrist.

It would take an investment in facilities and personnel for a health system to operate an integrated program, she says. Nevertheless, Nuss adds, “It’s the care of the future.”

Most patients have been receptive to the mental health component, says Anne Hernandez, director of the Grady integrated health program.

Dennard welcomed the regular visits with Johnson.

“They got me in there immediately,” she says. “I was angry about a lot of stuff.’’

The visits have been effective. “I feel better now,’’ Dennard says. “A lot of people are depressed and need someone to talk to.’’