Q&A: Marc Avery, MD, of the Advancing Integrated Mental Health Solutions (AIMS) Center

Although Psychiatry Advisor publishes the latest news, features and opinions relevant to your work, we also feel it’s good to go “behind the scenes,” and find out more about mental health professionals doing interesting work.

Our first Question & Answer profile is with Psychiatry Advisor editorial board Marc Avery, MD, a clinical associate professor at the University of Washington School of Medicine in Seattle, Washington. Avery also serves as associate director for clinical services at the Advancing Integrated Mental Health Solutions (AIMS) Center, which focuses on developing collaborative care models to better involve primary care physicians in the treatment of mental illnesses.

Psychiatry Advisor (PsychAd): Dr. Avery, you focus is on integrated behavioral health services in community health. Why did you decide to specialize in this?

Marc Avery: My subspecialty is consultation/liaison (CL) psychiatry. Specialists in this field work in the intersection between physical health and mental health. In my early years as a CL psychiatrist, I became painfully aware of two fundamental problems in our mental health care delivery system.

First, my patients at the community mental health center often received mental health care that had little coordination with their medical care, often with less-than-optimal results.

From the other end, my primary-care colleagues were usually highly frustrated with their ability to even access psychiatric care for their patients. These primary care clinics and mental health clinics were often excellent in their own ways, but they just didn’t seem to have a way of coordinating with one another.

I was immediately attracted to the IMPACT model of care [focused on collaborative care with primary-care physicians] that came out of the University of Washington under the direction of J ü rgen Un ützer, MD, MPH. The model made a lot of sense, had remarkable outcomes and cost savings data, and appeared to be generalizable to other settings.

So, I jumped at the opportunity, back in 2007, to participate in a project that provided integrated care to a safety net population across Washington State called the Washington State Mental Health Integration Project.

PsychAd: How did the University of Washington’s AIMS Center get started?

Avery: The AIMS Center was founded in 2008 to promote integrated models of care via research, implementation support, and education. Our services are based on research started back in the 1990s by Dr. Unutzer. The original research focused on depression, but since then the model has been expanded to include other conditions — a model that we now refer to as collaborative care.

We have about 20 faculty and staff in the center now, and over the years we have helped many dozens of programs to implement integrated care. 

PsychAd:  What have you learned from your experiences at the AIMS Center that can applied by other mental health professionals?

Avery: There are different ways to think about how we provide services and there are opportunities to improve our effectiveness. At the AIMS Center, we like to refer to the five principles of integrated care: person centered, population based, targeted to outcomes, evidence based, and accountable. I would say that all mental health professionals should work to incorporate as much of these five principles into their care regardless of their type of practice.   

PsychAd: Do you find that primary care physicians are supportive of the collaborative care model?

Avery: In general, I have been pleasantly surprised by the support that we have received from our primary-care colleagues. Perhaps initially this is because they are grateful to have any help with their patients, since in current practices, the majority of providers are frustrated with access to mental health care for their patients.

However, it is not very long afterward that many come to see integrated care as the best way to provide mental health care for many of their patients.

There’s no question that we ask primary-care providers to expand their comfort zone by providing a wider range of psychiatric treatments themselves — with the support of care coordinators and consultant psychiatrists. We have found that it is definitely important to provide the necessary training and implementation support up front in order to be successful.  

PsychAd:  There’s a tremendous need for mental health resources in the community health setting. What has the AIMS Center been doing to address this, and what more needs to be done?

Avery: The AIMS Center is all about leveraging psychiatric resources to reach the most patients as possible and to maximize our effectiveness. We do this by promoting a model of care that efficiently utilizes costly and scarce resources. 

One aspect of maximizing our effectiveness is the idea of asking all clinicians — especially physicians — to practice at the “top of our competency band.” In order to do this, clinicians need access to real-time clinical information along with clinical decision support. We encourage this through the use of clinical support tools, such as patient clinical registries and symptom tracking tools.

PsychAd:  What is the greatest challenge facing psychiatry and psychiatrists today?

Avery: Wow, that’s a big question! I’m not a mental health epidemiologist, but I would say much of the answer lies in the fields of public health and mental health prevention. For instance we are becoming increasingly aware of the huge role that childhood adverse events — and traumas in general — play in the health of our communities.

There is lots of work to be done to eliminate, or reduce the impact of, the risk factors that can lead to psychiatric symptoms and conditions. For other conditions, we can do a much better job of screening to detect cases early before symptoms become severe.