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The Largest Health Disparity We Don’t Talk About

The Largest Health Disparity We Don’t Talk About


Across the country, heart failure patients leaving the hospital are routinely seen in specialized clinics within a week of discharge. Not so for psychiatric patients, who often wait months before seeing a mental health professional.

To narrow that gap, UT Health San Antonio created a transitional clinic for patients with mental illness discharged from hospitals and emergency departments throughout the city. The goal is to get these patients evaluated within days. They meet with psychiatrists, social workers and therapists. They receive training in how to buy groceries and use public transportation. They’re visited at home by case workers who help organize not only their psychiatric drugs, but also their cholesterol and blood pressure medications.

“With the right kind of care, people with serious mental illness can integrate back into society,” said Dr. Dawn Velligan, professor at UT Health San Antonio and a director at the clinic. “They can have regular jobs, relatively normal lives. We just need to intervene before things get unmanageable.”

Early results are promising: Historically, about 7 percent of psychiatric patients return to the hospital within a month, but only 1 percent of those seen in the transitional clinic do. Despite the program’s success, inconsistent funding has limited the number of patients the clinic can reach — a reflection of how society continues to undervalue mental health.

“When there’s a commitment to these patients, there’s a lot we can do,” Dr. Velligan said. “But right now, they’re not a priority. People have to want to care for them. We have to care.”

After decades of fragmenting medicine into specialties and subspecialties, it’s perhaps not surprising that a siloed system often fails those in need of whole-person care. I still sometimes wonder if I had let my patient’s mental illness overshadow his physical needs. Did I overlook some subtle cue?

I may never know the answer, but next time, I hope I’m not asking the question.


Dhruv Khullar, M.D., M.P.P., is a physician at NewYork-Presbyterian Hospital, a researcher at the Weill Cornell Department of Healthcare Policy and Research, and director of policy dissemination at the Physicians Foundation Center for Physician Practice and Leadership. Follow him on Twitter at @DhruvKhullar.





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