CNHSA offers intergrated behavioral health services, building a healthier Nation

By Chris Jennings
December 1, 2021

According to Mental Health America, over half of adults with a mental illness do not receive treatment. The Choctaw Nation Integrated Behavioral Health Care program aims to improve that among tribal members living within the boundaries of the Choctaw Nation.

Integrated behavioral health is a term for having behavioral health therapists in a primary care setting.
Carly Blemmel is one of the five integrated behavioral health therapists for the Choctaw Nation.
According to Blemmel, this is an essential service.

“By having an integrated behavioral health clinician or an integrated behavioral health therapist in a primary care setting, you’re treating the whole person by treating their physical, emotional and mental needs,” explained Bemmel.

Primary care physicians increasingly rely on the services of integrated health therapists. This increased access to therapists across the Nation improves treatment planning while reducing the stigma associated with seeking mental and behavioral health treatment.

This more holistic approach to health care ensures that patients walk away more satisfied and better able to deal with the conditions that require a medical visit.

It’s not just the patients that benefit from this. Providers are also more satisfied that their patients will get the care they need when an integrated health therapist is available to work with patients.

Mary Boerner, a Certified Physician Assistant at the Women’s Health Clinic in Talihina said, “Integrated Behavioral Health is a game-changer for both the patient and the provider. An integrated therapist increases my confidence that all the patients’ needs are being met when they come into my clinic.”

Blemmel adds, “By addressing it in a primary care setting and providing education and resources and brief interventions for that patient, we can keep patients out of the emergency room.”

An integrated health therapist can help with things like pill swallowing and fear of needles.

If someone is afraid of needles, their stress levels can go up when visiting a doctor. The therapist can do brief sessions with that patient in the clinic or hospital to reduce their anxiety levels. They can also do short sessions on pill swallowing for both adults and children.

“One of the biggest predictors of health outcomes is patient behavior. Doctors can give a diagnosis and prescribe medication, but if the patient doesn’t take the medication or doesn’t adhere to the behavior recommendations, then their health outcomes aren’t likely to improve,” said Blemmel.

An integrated health therapist can also help with things like goal setting. A patient may be having a tough time following their doctor’s recommendations or taking their medications. If they are, they can speak with an on-site integrated health therapist who can help the patient with some brief goal-setting suggestions to help make sure they follow through with the doctors’ recommendations.

In many cases, this is all they need. “They just need somebody to get them moving in the right direction,” said Blemmel. Other times it may not be as simple as that.

As many as 80% of patients with behavioral health problems go to the emergency room or a primary care clinic. While an emergency room is the best place to get emergency care, they’re not often the best care solution for behavioral health problems.

Many patients in a behavioral health crisis don’t need medical care. They haven’t physically injured themselves and don’t have any other health conditions. The providers in those settings don’t always have the resources to address these problems, especially when dealing with depression, grief, or suicidal ideation.

The COVID-19 pandemic has been responsible for millions of deaths and infections due to the virus. That brought extra, or new, anxiety, stress and grief to many people’s lives. An integrated therapist can help individuals get the proper care with a referral to support groups to get the help they need.

One of the places Blemmel spends a lot of her time as an integrated therapist is at the Women’s Clinic in Talihina. She says the Women’s clinic is more fully integrated where the provider and the therapists are collaborating more on treatment.

“In the women’s clinic, integrated therapists are used to support many health outcomes in a holistic approach, not just for depression and anxiety, “said Blemmel. One of those ways is by talking to women after giving birth.

Taylor Best delivered her son at the Choctaw Nation Health Care Center in Talihina recently and was pleased with every part of her labor and delivery experience. There was one part that she found to be extremely helpful, though.

“The day after I delivered my son, Carly came to check in on my mental well-being. I cannot stress how important and crucial her services were as I was navigating so many new thoughts, emotions and my new role in motherhood,” said Best.

“In the women’s clinic, I do a lot of prevention. We talk about postpartum support and communication along with some family systems things that we do,” said Blemmel. Best says she’s grateful for having Blemmel help her through recovery. “Because this was my first time having a baby, I thought having someone like her to talk to was the standard. Mental health goes hand in hand with physical health,” said Best.

Integrated therapists can also identify non-medical issues that may pose a risk to patients, preventing them from getting the care they need. Blemmel gives an example saying, “It’s hard to focus on something like your sugar if you don’t have a roof over your head or food to eat. We’re also making sure that we’re connecting patients to all that they need so that they can be their healthiest selves.”

The Nation has many services available to people for help. Sometimes navigating those services while also under the stress of a medical or behavioral health visit is difficult. Integrated therapists can serve as a sort of middleman, relieve some of the stress and help to ensure treatments are successful.

By making clinic visits and emergency room care less stressful for both the patient and provider, the Choctaw Nation integrated health therapists are helping to build a healthier Choctaw Nation.


Prevalence of Mental Illness Chart

*Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic.NH/OPI = Native Hawaiian / Other Pacific Islander | AI/AN = American Indian / Alaskan Native.