Minnesota Integrated Behavioral Health

Program Description

The Minnesota Integrated Behavioral Health (IBH) Program, which operated from 2015-2018, offered targeted support to three cohorts of Minnesota critical access hospitals as they worked to better integrate behavioral health resources and services into their care model. Hospitals were assisted in hosting community-wide strategic planning sessions and implementing best practices.

The program was funded by the Minnesota Department of Health’s Office of Rural Health and Primary Care, through its Medicare Rural Hospital Flexibility (Flex) Program.

When our hospital and community partners started working together, we found that the smallest changes made the biggest impact — communicating, teamwork, and learning and understanding each others’ processes. That made the biggest impact.

Dawn Schnell, Senior Director, Sanford Jackson Medical Center

Participating Hospital Outcomes

• Increased access to behavioral health (BH) services
• Decreased transfers to inpatient settings
• Increased “discharge to home"
• Decreased cost of transferring emergency department (ED) patients and decreased cost of ED visits
• Decreased ED visits and admissions 
• Decreased mental health holds
• Decreased Patient Health Questionnaire (PHQ-9) scores at six-month follow-up 
• Decreased jail-psychiatric transfers

Major Accomplishments

• Improved collaboration among agencies led to decreased holds placed on patients
• Improved care coordination
• Upgraded suicide screening
• Increased education provided to ED nurses resulted in increased use of crisis mobile units and decreased length-of-stay
• Added a social worker who had been trained as a quasi-community worker to act as a resource for the ED
• Increased school utilization of crisis teams rather than bringing students to the ED
• Implemented a community paramedic program
• Added a psychologist on staff
• Increased telehealth use
• Increased outpatient medication management with a nurse practitioner to decrease the need for inpatient care
• Improved communication among agencies through the creation of a universal release of information
• Improved assessment of cardiac rehab patients for behavioral health issues in order to offer them stress management
• Improved prevention of acute situations
• Provided system-wide mental health first-aid education for nurses 
• Created a community-wide behavioral health resource directory
• Created a "roving therapist" position to counsel inmates with depression and anxiety, resulting in zero inpatient psychiatric transfers

Common themes emerged from IBH projects in three areas: the targeted population for projects, project goals, and strengths and barriers. 

Intended Population

More than half of all participating hospitals focused project efforts on adults who present to the ED in a BH crisis, adults who present to the ED with depression or anxiety, or adults with alcohol/substance use disorders. Other hospitals (23%) focused on younger community members and their families, aged 5-40 years old. A smaller number of hospitals (15%) focused on all ages of patients presenting to the ED in a BH crisis.

Project Goals

• Decrease ED visits through increased outpatient management and coordination of care 
• Discharge patients appropriately with the right supports to maintain stable mental health status
• Determine the appropriate level of triage for those in a BH crisis
• Identify community resources and gaps in care with the establishment of a community-based care coordination team
• Improve processes for tracking referrals and care coordination
• Reduce police department interventions; decrease rapid response; improve student achievement; increase safe zones
• Prevent or reduce BH crisis-related readmissions to the ED
• Obtain faster screenings to reduce readmissions to the ED
• Create a directory of community services to improve provider knowledge, and patient access and utilization of community resources 
• Early identification to prevent BH crises

Strengths and Barriers

Hospitals and their communities worked together to identify gaps in care in meeting their target population's BH needs. Program participants also worked together to identify their strengths — what they were already doing to help their target population with BH needs. Common themes emerged among the strengths and barriers.