Why Dr. Scottie Day wants mental health experts in all clinics

Bolstering accessibility to mental healthcare at Kentucky Children's Hospital in Lexington is a key priority this year for Scottie Day, MD.

Dr. Day, physician in chief at Kentucky Children's Hospital and chair of pediatrics, spoke with Becker's about his outlook for mental healthcare and goals for this year.

Note: This conversation was lightly edited for clarity.

Question: What are you looking most forward to in 2024?

Dr. Scottie Day: I think for our healthcare in general we are most looking at how to best treat a population. In the arena where I work, it's about children. We hear a lot about mental health and we think about how to approach the comprehensive health of children all the way into their older years. I don't like to separate physical and mental health, but how as an organization we take care of them. This goes beyond just treating whatever illness or whatever thing is going on. I'll say it's beyond just treating the fracture. All those other things that contributed to the fracture are things that contribute to the overall health. A lot of that we termed social determinants of health. So how do we best address that, and how do we partner and leverage relationships that we have of people that may already be doing that both to save resources, but also to make sure that we're providing the very best care to our patients?

Q: What does that look like at your system — that collaboration on addressing physical health and mental health? 

SD: For us, for example, when we look at our children's specialties, access is an issue in so many different areas. So how do we maximize access so that the patient's coming in for a treatment by our pulmonologist or by our immunologist or whatever that may be? We want a mental health expert in every single clinic. So having a psychologist or sometimes a social worker, depending upon the needs, that is really what we want to do. We want every clinic to have that kind of access, and we really want to value it. We know that we're dealing with teams and with with individuals dealing with suicide rates that are beyond what we could ever imagine. So how do we screen these kids and then get them to the appropriate treatment and the appropriate therapies as well?

Q: Do you have any particular processes implemented to do those mental health screenings? What does the staffing look like on the mental health end? 

SD: I think we have a really good screening process. One of our quality metrics in the state of Kentucky for children is to be able to do these screening and for adults as well. So it's a part of our regular workflow that our staff, when they do intakes, it's a part of the overall daily thing. Just like when you get vital signs, we make this a part of that process. The more challenging part is when you identify it, do you have enough people to address it? That's where we need to increase staff and understand what that may be. Although we're in Lexington, we serve the entire state of Kentucky. Something we can do, it could be telemedicine, or partner with other organizations that provide those services that are closer to home because, you know, coming in here for an appointment is one thing. Coming in here on a regular basis,  ti's very challenging economically, very challenging on work schedules. So we want to make sure that we do what we can to make sure they get the appropriate care, but also that we make it as easy as possible.

Q: To what extent have you explored partnerships when it comes to the behavioral health end of things?

SD: We do that a lot, actually. For behavioral health in certain areas, we are not just partnering beyond, but we partner within the university. We sit on a healthcare campus that's part of a university, and we work with those colleges to train more people. We have a postdoc psychology program so that we can not only train those people, we also try to retain those individuals. Let's say we train them and they go elsewhere. Then that's fine, because then we have this person out in practice in another part of the state that we know is going to provide the most quality care. 

The strongest thing that we have at our organization is our partnerships. These may be in a variety of ways. These may be from a neonatal ICU standpoint, they may be from the community, they may be from different specialties. And so a lot of times we just get everybody in a room and say, "How can we best address this?" At the end of the day, for a lot of this, there are more patients than there are providers to address. So it's not a competition when you're talking about this kind of care.

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