When Complex Medical Needs Meet Mental Health Challenges: How Collaborative Care Can Help

For David Liebovitz, MD, an internal medicine physician at Northwestern Medicine, becoming a physician was never about focusing on one organ system. It was about the challenge and privilege of caring for the whole person.

“I’ve been doing this for a long time,” he says. “What appealed to me was the breadth and depth of the scope of caring for patients and being able to problem-solve and help patients with a wide variety of problems.”

Today, those problems frequently include significant mental health concerns layered on top of complex medical conditions. Dr. Liebovitz practices in an academic general internal medicine setting at Northwestern Medicine, caring for patients who often come to the system for advanced oncologic care, transplant services and treatment of rare diseases — and then stay for ongoing internal medicine care.

“Our patient population is medically complicated,” he says. “Like the population at large, they are often affected by mental health challenges and may require specific treatments to address mental health concerns and diagnoses.”

Barriers to mental health care

For these patients, access to mental health care is often the limiting factor.

“Access to mental health services has always been very difficult,” says Dr. Liebovitz. “It’s even more difficult when patients are struggling with mental health issues and have medical issues on top of that.”

The Collaborative Behavioral Health Program (CBHP) at Northwestern Medicine has helped change that equation. All patients in Dr. Liebovitz’s practice are screened at least once a year for depression and anxiety using tools embedded in the electronic medical record (EMR). In the past, a positive screen launched a time-consuming search for an available psychiatrist or therapist.

“Previously, I scrambled to find a psychiatrist or other mental health professional for my patients to see,” he says. “Now we have recourse for patients who are having more severe manifestations evident from screening to be seen in a timely way. It’s a relief as a physician attempting to help these patients improve.”

Seeing improvements in his patients

Through CBHP, patients with concerning scores are quickly contacted, assessed and enrolled in collaborative care by a behavioral care coordinator (BCC). Their treatment protocol can include therapy, medication management or both. Phone visits often make it easier for patients with mobility, transportation or time constraints to engage in care.

“Being able to give that handoff where I have the confidence that my patients will be contacted within a few days after a referral is reassuring,” says Dr. Liebovitz. “My patients have very much appreciated this opportunity to get enrolled and managed and have shown improvements.”

Those improvements are felt well beyond the exam room. Patients who once scored in the severe range on screening tools often experience better functioning at home and work after titrated medication therapy and direct counseling.

“We have a variety of success stories where patients have struggled for an extended period, then enrolled in the CBHP and within just a few months have shown progress,” he says.

Many ultimately need only routine mental health follow-up during primary care visits, with the option to re-engage with CBHP if symptoms recur.

Implementing CBHP into everyday workflow

From a physician's perspective, the program’s design and integration into daily workflow matter. As an early adopter of the program, Dr. Liebovitz has used the model for years. A dedicated storyboard in the EMR places screening results and program updates at his fingertips, and the behavioral health team sends clear messages to his inbox about next steps for his patients.

“The system isn’t too much to learn,” he notes. “It integrates well into my normal workflow.”

His advice to other Northwestern Medicine primary care clinicians exploring collaborative care is simple: “If a patient screens positive on a depression or anxiety screening, take it seriously and follow through with the rest of the questions. You now have a resource to help your patients who are most in need of mental health care.”

Looking ahead, Dr. Liebovitz is encouraged by ongoing refinements to communication and reporting that will help physicians see each patient’s trajectory more clearly. For him, collaborative behavioral health is not an add-on, but rather an essential part of whole-person care.

Learn more about the Collaborative Behavioral Health Program at Northwestern Medicine.