A frequent conversation held in my home is how counseling can support medicine. My husband is currently a medical student in his third year and going through rotations where he sees numerous opportunities where counseling services for patients outside of the doctor’s office could be beneficial. As a counselor, I also notice numerous instances where we would benefit from being more integrated into the medical healthcare system. Despite the potential gains for our clients/patients from developing a continuity of care, we often seem to remain pigeon-holed. How many private practice clinicians actually collaborate with client’s psychiatrists? How many doctors prescribing antidepressants provide referrals for counseling?
One of the most critical instances where we miss opportunities to create a better continuity of care are ER trips for suicidal ideation. I have personally transported clients who were homeless in previous positions who were clearly a risk to themselves. At best, the hospital declined to admit clients, while at worst, I was fortunate enough to catch a client as he ran across the parking lot after being discharged. The hospital had forgotten to pass along my request that I be contacted once they decided to admit or not. My husband recently shared a story of a woman who self-referred for suicidal ideation and was subsequently discharged with a next-day counseling appointment. She missed it and later that day attempted to kill her newborn child and herself.
These examples beg the question of how to better an ER department’s follow up after patients are admitted and sometimes inappropriately discharged. Communication among hospital staff is a clear place to start – my requests to be informed of client’s discharge or to speak with psychiatrists was not relayed to a physician by admission’s staff. Another consideration when ERs do refer to counseling services is to take accessibility into account. In the situation previously described, the person did not have transportation to the appointment. Asking about this or checking to see if the appointment had been kept could have prevented a tragedy.
ERs are also a place where people often go after life-threatening incidents such as car wrecks or gunshot wounds. Patients may also receive diagnoses of life threatening illnesses in hospitals. This is an area which I can speak to personally – I was hit by a car when I was 15 while crossing the street. I was lucky, requiring only 3 surgeries on my ankle, but my psychic injuries were at least equally significant. For the following two years I almost certainly met criteria for PTSD - I struggled to rectify the incident with my conception of God, lost enjoyment in my hobbies, and experienced suicidal ideation for a period following my surgeries. I was referred to physical therapy, but never to counseling services. They would have been helpful.
Other less extreme examples of how counseling services and doctor’s offices miss helping one another is to address much more common medical issues such as diabetes or hypertension. While it seems that doctors have some training in motivational interviewing, there tends to be very little time to employ these skills. What would it look like for a patient who was just diagnosed with diabetes to not only receive treatment and some education but also to come into contact with a counselor who engaged them about their mental and physical health and the event of the diagnosis? This counselor could meet with the patient after subsequent appointments, becoming a more regular provider or give referrals.
Overall, I spent very little time in graduate school learning about the continuity of care between the hospital and mental health services. My husband sees that this same gap in knowledge is present in medical school. Perhaps some of that is due to our gravitation away from the medical model as a profession. Research demonstrating a need or effectiveness may not be there yet. Doctors may not know who they could refer to, or counselors may not be effectively marketing their services to doctors. Regardless of the reason, it seems apparent to me that there is room for developing a stronger relationship between our fields. Doing so will result in not only a reduction in cost for our healthcare system, but also an increase in effective treatment for our clients and patients.
Ben Hearn is a new professional who is currently working as a school-based counselor. He is passionate about working with trauma and enjoys applying the fields of neuroscience, philosophy, ethics, and psychopharmacology to counseling practice.