Teamed up for treatment

BOULDER — When John Shokett moved to Boulder County five years ago, he was struggling with depression and desperate to see a therapist.

Shokett, now 68, was referred to People’s Clinic in Boulder, one of five clinics of Clinica Family Health Services, a local nonprofit health-care group.

When Shokett got to People’s, he explained his problem and was seen immediately by Michael Dow, a psychologist at the clinic. Dow dropped what he was doing and invited Shokett into an exam room for a quick chat, Shokett said.

Shokett said he had just gone through a divorce and had been living on his brother’s couch in Las Vegas before moving to Boulder. He likens the depression he felt at that time to a wound that felt physically painful. Since then, Shokett said, he has had a therapy visit once every two weeks and now feels much better.

“It was like I was his (Dow’s) only patient in the world, which really helped me,” Shokett said. “I was incredibly depressed.”

Dow said he was able to meet with Shokett right away, because Clinica focuses on integrative health – meaning that behavioral-health specialists are part of a team of health providers that includes doctors, nurses, physician assistants and others.

No statistics are available on how many behavioral-health providers have joined primary-care doctors across the nation, but the number is on the rise, Dow said. Clinica made the administrative change about six years ago.

With an estimated 30 percent of all patient visits to doctors related in some way to issues of depression, anxiety or stress, Dow said, it makes sense to have behavioral-health providers be part of the equation.

Primary-care doctors treat 80 percent to 90 percent of patients complaining of depression in the United States, other studies show, Dow said, adding that patients don’t usually go to mental-health specialists when they’re referred by doctors.

Sleep problems, lower back pain and “chronic” pain can be signals of depression, said Susan Wortman, development director for Clinica Family Services, which also includes clinics in Federal Heights, Thornton and north Denver.

About 30 percent of people who complain from dizziness have an anxiety disorder, Dow said, adding that irritable bowel syndrome can be a signal of depression as well.

Patients who complain of one of the possible symptoms are given a questionnaire to fill out, Wortman said. From there, the patients are referred to behavioral-health specialists affiliated with their doctors, she said.

As a result, more than one-third of all patients to Clinica’s Boulder and Lafayette clinics also received some sort of mental health treatment in 2011, according to statistics compiled by Anthony Porcaro at Clinica.

Treatments were for alcohol and other substance-related disorders, mood disorders other than depression, attention deficit and other disruptive behavior disorders, other mental health disorders and anxiety disorders, including post-traumatic stress syndrome, Porcaro said.

Clinica’s integrative-medicine approach to mental health comes from Pete Leibig, president and chief executive of the organization. When it comes to health, the mind and body are connected and can’t be treated separately, Leibig has said. So if a patient comes in complaining of aches and pains, Leibig and others in the health-care field believe it’s often depression-related.

In fact, people suffering from depression-, anxiety- and stress-related illnesses are believed to be the largest number of patients in the health-care system, both locally and nationally.

An estimated 60,000 people in Boulder and Broomfield counties have some sort of mental-health issue, according to Mental Health Partners, the nonprofit center serving the two counties with locations in Boulder, Broomfield and Longmont.

At Clinica, Dow said the integrative-medicine approach expands to fit any health issue. For example, he said, a patient complaining of lower back pain might also get a stress-management plan and an exercise plan from a behavioral specialist.

A person with diabetes, hypertension or obesity also may get an exercise plan, he said. So depression screening is a huge part of his work, but five or six other health behaviors also keep him busy, Dow said.

“One piece of it is medication, but a big part of it is changing behavior,” Dow said. “We talk about what is the obstacle to you doing an exercise plan or changing your diet and give you strategies for addressing that.”