Frustrated by what she calls a fragmented approach — in which mental health is "carved out" of many insurance plans, leading to patchwork care, poor communication and poorly served patients — Durbin, who also is regional medical director for managed care at Palo Alto Medical Foundation, aims to establish new procedures that could be used by thousands of doctors.
"We must start saving lives in our own communities now," Durbin said in a grant proposal to test new models of "collaborative care," in which mental health screening would become standard procedure, and patients at risk would be monitored.
Durbin cites the case of a teen with "profound sadness" and thoughts of suicide, who some years ago came to the Palo Alto Medical Foundation with her mother. The girl's primary-care doctor recommended hospitalization. After waiting for hours in the emergency room of a children's hospital, the girl was given an assessment with no privacy and sent to a different hospital that was licensed to admit teens with psychiatric issues.
The teen's experience was "humiliating and utterly distressing as her parents were not allowed to travel with her between hospitals," the teen's primary-care doctor said. "Her mother called me the next day, pleading that I help get her daughter released. As she was discharged from the hospital, I was told she had been connected with a therapist. Later, I found that this connection was tenuous."
The primary-care doctor received no communication from the therapist and never heard when the therapist stopped treatment.
"The teen could not bring herself to return to our clinic because of the traumatizing memories of the hospitalization," the doctor wrote. "I did have a few conversations with her mother, who reassured me that she was doing well."
But three years later, as she was about to graduate with honors from high school, the young woman died by suicide.
"I have often wondered whether events would have taken a different path had she not been so traumatized by the way our 'system' did not serve her," the doctor wrote.
Fragmented mental health care — often driven by insurance reimbursements — means there's not necessarily any coordination, or even the most basic communication, between a teen's therapist or psychiatrist and her primary health provider.
Durbin, whose three sons were Gunn High School students at the time of the suicides in 2009 and 2010, knew some of the families of the students who died and was deeply affected by the suicides.
Following the second student death in June 2009, she was among the physicians who organized the medical community's response to the events, launching HEARD (the Health Care Alliance for Response to Adolescent Depression).
In the three years since, HEARD has amassed a huge amount of medical data and guidance on its website and has removed password protection of the site so it's now freely accessible.
In her own Palo Alto medical practice, Durbin said, "I absolutely screen (for mental health) now — not just with children but also with adults."
Even so, she said, it's not yet an "embedded guideline that everyone screen." Hence, her effort to change procedures more broadly within Palo Alto Medical Foundation and even throughout the vast Sutter Health Care System — with 48,000 physicians in 100 Northern California cities and towns — of which Palo Alto Medical Foundation is a part.
Durbin is seeking backers for a $3 million, five-year pilot program with the goal of establishing a nationally recognized model of care "that will transform the delivery of behavioral health care within our region, beginning with our adolescent population."
The pilot will test three primary-care approaches to mental health screening and care for teens and measure the results.
The results, she said, will yield "an effective, standardized protocol for identifying, treating and preventing behavioral disorders within the primary-care setting" — a protocol she hopes will propel changes nationwide in approaches to teen mental health.