In recent decades, trauma care professionals have made significant progress in reducing the burden of injury. But according to Samir Fakhry, MD, chief of the division of general surgery at the Medical University of South Carolina (MUSC), there is one area that needs more attention — the treatment of mental and emotional health after discharge.
Dr. Fakhry is the chairman of the Trauma Center Association of America (TCAA). He shared his thoughts on this challenge during his keynote session at the TCAA’s 2016 Annual Conference. His presentation was entitled Continuing Trauma: The Unmet Needs of Trauma Patients in the Post-Acute Care Setting.
“We have figured out how to address some of the big killers, and we have designed not just trauma centers but trauma systems,” Dr. Fakhry said in a separate interview. “However, we have focused mainly on acute care, and I think now is the time to consider expanding our focus to the post-discharge emotional health issues that also represent the burden of injury.”
A system issue
“This is something I care about a lot, and it is an increasingly important part of what our patients and their families face after they leave the trauma center,” Dr. Fakhry said.
While as many as half of trauma patients experience significant psychological and emotional health issues following their injury, people with a strong personal support network are more likely to do fine. However, a significant number of patients struggle with depression, anxiety, PTSD and other problems for years.
“As we all know, we need to think about what we do as a trauma system that encompasses all aspects of injury care,” Dr. Fakhry said. In recent years, trauma leaders have expanded their efforts to injury prevention and also advocacy. “Now, as part of a truly comprehensive approach to injury, we need to look at the unmet needs in post-discharge care for trauma patients.”
Effective programs
At MUSC, Dr. Fakhry and colleagues have created several programs focused on post-injury mental health. The team developed and studied a smartphone app that serves as a mental health screening tool for trauma patients in the post-acute period. According to Dr. Fakhry, patients responded very strongly to the concept.
Dr. Fakhry also described the MUSC Health Telehealth Resilience & Recovery Program, which was launched one year ago. In this program, staff provide in-hospital education to trauma patients on mental health recovery and resources. At that time, patients are offered the opportunity to receive a phone screen for mental and emotional health 30 days after discharge. “About 97% of patients agree to the screen,” Dr. Fakhry said. “Almost everyone jumps at the chance.”
Of patients who receive the 30-day phone call, about 40% screen positive for unaddressed mental health needs. These patients are offered a comprehensive assessment and best-practice treatment via telehealth. Referrals to local mental health professionals are provided as needed.
According to Dr. Fakhry, about 60% of patients who screen positive for mental health issues accept treatment. The team has found that patients are strongly interested in receiving services by telehealth.
Resource challenges
Dr. Fakhry noted that securing funding for post-injury mental health programs can be a challenge. “The good news is that some of the most effective models are volunteer programs that rely on the efforts of survivors and family members.” He noted the programs available through the Trauma Survivors Network.
Dr. Fakhry encouraged trauma leaders to begin seeing non-physical injury as part of their mission. “The first thing to do is to recognize that this is an unmet need and begin to create awareness around these issues.”