A pilot program at Cornell University, a highly diverse international community of 22,000 students, demonstrated the value of an embedded behavioral health consultant (BHC) as a cost-effective, accessible, culturally sensitive approach to providing mental health care.
Each year nearly 80 percent of students use Cornell's campus medical services, and about 18 percent access mental health services, both for a nominal $10 per visit charge. Though staff share an electronic record, students access counseling and medical services through separate intake processes. Demand for mental health services continues to grow, and surveys suggest that as many as 40 percent of students could benefit from mental health care. Some of this need is experienced by medical providers as growing complexity in medical presentations. Though university leadership recognizes the importance of health to its academic mission, it would be prohibitively expensive to meet the estimated need of the student population with traditional mental health services. Additional barriers included the time required for treatment and the perceived stigma that many students have towards mental health care.
As a one-year pilot effort aiming to cost-effectively increase the quality of medical care and the reach of mental health services, a behavioral health consultant was embedded in a medical unit and assigned to work with four clinicians. The experiment proved highly successful. Students, including many who said they would not have sought traditional mental health services, found BHC interventions to be very helpful. The clinicians reported that the partnership increased the effectiveness and cultural sensitivity of their care. Mental health staff developed new appreciation for the volume and significance of mental health concerns presenting in the primary care setting. The program reached under-represented minorities, international and graduate students well beyond their proportion in the general student population, which was particularly gratifying.
Based on the success of this pilot, Cornell University Health Services Executive Director and Associate Vice President Janet Corson-Rikert, MD, decided to expand the program as a key component of their integrated health program. The program includes one behavioral health consultant on each medical team.
When asked about lessons her team would share with others implementing similar programs, Dr. Corson-Rikert suggested:
Set up an interdisciplinary team to support the BHC and enable nimble problem-solving around operational challenges
Leverage the BHC's expertise for both behavioral and cultural concerns
Use regular case reviews to facilitate education and team discussion based on BHC experience