Leopoldo Pozuelo, MD, says physicians are paying closer attention to mental health, even when patients are admitted for non-behavioral conditions.
The stigma around seeking mental health treatment is lessening, but access remains a challenge, Dr. Pozuelo, chair of psychology and psychiatry at Cleveland Clinic, told Becker's.
The clinic recently teamed up with TikTok to provide reliable information on mental health conditions on the platform, and it is working to co-locate more behavioral health services in primary and other clinics and empower primary care physicians to ask the right questions about mental health.
Dr. Pozuelo sat down with Becker's to share Cleveland Clinic's current mental health initiatives and how the behavioral health space has evolved over his 26 years at the health system.
Editor's note: This conversation has been edited for length and clarity.
Question: What are you seeing in terms of young people's mental health at Cleveland Clinic right now, and what kind of misinformation is out there on social media or other places?
Leopoldo Pozuelo: The impact of the pandemic, psychologically, has been huge. I think the silver lining of this has been that it's raised the awareness of mental health at the local level, at the national level, and the surgeon general putting that at the forefront. People reach for information quickly. There's so many resources. But I think at the expense of the search for the information, there's a natural inquiry, and people want to be resourceful, and they want to do things on their own, which is, I think, good in getting those self-assessments and getting correct information.
I think the stigma is less, and I think that's been a positive aspect of that. But there are still pockets where there's misinformation as far as the treatments, or there's misinformation as far as the diagnoses. If you look at our health library, they really look at two things: raise awareness and provide resources in a medically grounded format. I think that's really the message that we have, and we'll continue to do that.
Another interesting aspect of that is how [patients] seek information from non-behavioral health colleagues. A lot of the first inquiries are going to be dealt with by their primary care physicians or their OB-GYNs. So it's important to get all that information upfront and make sure that it's all factual.
Q: Do you have any initiatives around integrating primary and behavioral care at Cleveland Clinic right now?
LP: One is with school-based mental health programs, and providing pediatrics and psychiatry, having those psychiatrists in schools. That's something we've been doing for a couple of years. It's really uncovered a lot of good results, treating people just in time, and sometimes [treating] the family members as well.
Another initiative has been looking at where we place our psychiatric consultants. In the old days, we put people in family health centers, and they'd kind of be remote in a room by themselves, and the patient would come and go but there was no integration. So strategically placing some of our psychiatric hubs that we have in Cleveland on the same floor or the same building as our primary care, internal medicine, family medicine, and OB-GYN offices. I really think that does a lot to say, "Hey, I have a colleague upstairs, or a colleague down the hall." That serves to break down barriers.
It's really important to lift the behavioral acumen of our non-psychiatric colleagues. We just completed a family medicine update series, which we do every year. It's a terrific review course for all the family medicine practitioners, and this is the first time that we had a whole day just dedicated to mental health. So we have topics on diagnosing depression, bipolar disorders, updated psychopharmacology, what are the psychotherapies indications. We also talked about substance use. What I gathered from the course director, it was very well received.
You have to keep them in mind, your colleagues, in helping them lift that acumen, help them ascertain the issue at hand, ask the right questions and help them feel more comfortable in triaging [behavioral health] and potentially taking on some of the initial treatment.
Q: How has mental health evolved over your time in practice?
LP: I think we've seen the benefit of the better focus on the spotlight on mental health, because you can see that our patients, that they're asking for that, even if they're admitted for medical-surgical.
I work a lot with the cardiology teams — we have co-located clinics with them. They have been much more mindful as to the psychological adaptation and the emotional wellness of the patients that they see. There's great data out there that there's a mind-body connection, and it's important to have physical wellness and also emotional wellness in diseases such as heart disease. So, I'm pleased to see that.
The challenges are people are pressed for time. There's an increasing demand on all the services. That unit of time, that quality time that you can spend with patients — how do you capitalize on that so you can get the big picture? These are ongoing efforts that we all have, but over the years, it's really been easier to have these conversations with the patients. I know that our colleagues are bringing up the psychological aspect of our patients when they're hospitalized, in the medical-surgical, so I have to be very encouraged by that.
Q: What are the biggest barriers to access in behavioral health, and what are you doing to address those?
LP: I think it's less of a stigma issue than it was before, and more of an access issue. We have a silver tsunami of psychiatrists, for example. They're retiring at higher rates than we're getting people in.
I do think that the TikTok example is illustrative, of not so much the barrier but the challenge, of getting people into the right lane of information. I think what happens after that, is where we all have to work together, getting that individual to the right level of care. Mental health, medical care can be daunting. How do you help the patient navigate that? I think that's where the work is still to be done.
I'm really glad that the stigma is less. I'm really grateful for initiatives that have happened — the surgeon general's message, for example. He came to Cleveland, it was just so powerful. He spoke to everybody in the clinic about loneliness, his concern about the state of our youth. But it's connecting them to the providers, that's a missing piece. I think it's a challenge where we have to work smarter. That involves the insurers, that involves the hospitals, and involves the outpatient providers, and involves community resources. So we need to continue to tackle that.