May 1, 2017

Bringing a personal touch to life-changing care

Delivering high-quality mental health care means adding the personal touch to advancements in protocols, medications and technology.

Compassionate. Connected. Convenient. These words should describe the care people receive when they seek mental health services.

Kaiser Permanente is committed to total health — an approach to care that considers all aspects of a person’s state of being — body, mind and spirit. Delivering high-quality mental health care means adding the personal touch to advancements in protocols, medications, and technology.

“Treating the whole person requires making human connections,” said Don Mordecai, MD, national leader for Mental Health and Wellness at Kaiser Permanente. “The quality of these connections, the ‘fit’ between the patient and the therapist, can be the biggest factor in the outcome of the treatment. Every day, our care providers make these crucial human connections with the goal of putting patients at ease and giving them hope that they can get better."

Here is a look at three Kaiser Permanente mental health care providers who strive to improve people’s lives every day:

photo of Rebecca Coutin
Rebecca Coutin, psychologist at Kaiser Permanente's Los Angeles Medical Center

A journey to healing and recovery

May is Mental Health Month, a time to raise awareness about the importance of mental health, and to help fight stigma, provide support and educate about available resources for those in need of help. A special area of focus for Kaiser Permanente is the importance of young people getting the care they need. For psychologist Rebecca Coutin, it’s a cause she deeply identifies with.

“I have known since I was an adolescent that I wanted to be a psychologist,” said Coutin, who provides therapy services to adolescents and adults at Kaiser Permanente’s Los Angeles Medical Center. “I grew up in a family that was imperfect. However, I was fortunate to have parents who recognized that our family needed help, and they were brave enough to seek that help. We all went to therapy, and the power of what I experienced as a consumer inspired me to pursue a mental health profession.”

Coutin knows about the stigma that is too often associated with receiving mental health care because she experienced it at a young age.

“I have empathy for people who are ambivalent about seeking services or are ashamed about disclosing to their loved ones that they are coming here for mental health care,” she said. “I know what it’s like to sit on the other side. But I also know how important it is to get the care you need.”

By the time they get to Coutin, patients have taken that critical first step of seeking care. The majority of her patients come without a referral from a primary care doctor, which Kaiser Permanente does not require for its members seeking mental health services.

Patients who see Coutin get a clear message on their first visit: Her goal is to get them to a point where they don’t need therapy anymore. An important first step is for both patient and care provider to make a connection and a commitment to the therapeutic process.

“I tell them, ‘I want to be alongside you in your journey to healing and recovery,’” she said. “They have to believe the work we are doing together and the work they will be doing on their own can get them there. I want them to know there is hope, that there is a light at the end of the tunnel.”

The emergence of that light is measured by a tool called a Treatment Progress Indicator, an electronic questionnaire that patients complete using an iPad during every visit.

“Sometimes people may not feel they are getting better day to day, but when I show patients their current TPI results compared to their initial session, they see their progress,” Coutin said. “This realization can be extremely reinforcing to patients. The TPI allows me to provide care that is informed by the patient’s feedback.”

At some point, if treatment goes according to plan, Coutin and each of her patients start to talk about terminating therapy. For her, there is particular satisfaction when the patient initiates that conversation.

“I try to teach patients to be proactive versus reactive in their everyday lives,” Coutin said. “It is rewarding to see patients graduate from therapy knowing mental health services will be available to them if needed in the future. It is even more gratifying when patients independently recognize their own progress and voice their readiness to graduate from therapy with confidence that they have gained the insight and tools they need to thrive.”

photo of Cindy Pfluger
Cindy Pfluger, nurse at Kaiser Permanente’s Depression Care Management Program in Aurora, Colorado

No magic pill

Depression Care Manager Cindy Pfluger never sees the patients she helps and believes that fact sometimes makes the care she provides more effective.

Pfluger is a registered nurse serving patients in Kaiser Permanente’s Depression Care Management Program in Aurora, Colorado. She and nine other nurses and disease management specialists provide monitoring via telephone for patients who have been prescribed medication to treat depression.

The team makes sure medication is being taken correctly, tracks progress and makes adjustments as necessary. They work with other members of the care team to make sure patients who need other services — such as therapy or classes for coping with anxiety — get the most effective care.

While these patients have access to therapists if they need them, Pfluger said that many are more comfortable talking to a nurse over the phone.

“For some people this is still a very sensitive subject,” Pfluger said. “When their doctor tells them, ‘I am going to have a nurse follow up with you on the phone to see how you are doing on the medication,’ they are receptive to that.”

When she calls a patient for the first time, Pfluger administers a Patient Health Questionnaire (also called a PHQ-9), a best-practice screening tool used by Kaiser Permanente and other care providers to identify the degree of depression. In that first call, she also explains the side effects of the medication and stresses the importance of not expecting instant results.

“There is no magic pill,” Pfluger said. “These medications take time to work. We give patients a realistic idea of what to expect, and if they end up needing an adjustment to the dose, we can do that.”

The PHQ-9 is administered at regular intervals through phone calls during the course of treatment. The main focus is medication management and tracking the patient’s progress, but Pfluger and her colleagues also advise patients on lifestyle changes — like exercise and healthy eating — that can greatly speed recovery. Often, the regular personal connection contributes to them getting better.

“We are people they can talk to about what they are going through,” she said. “We hear a lot about their challenges, and they can call us as often as they want. I try to take note of some detail in each person’s life — whether it’s a hobby or a pet or a trip they took — so we can talk about something beyond just, ‘How are you feeling?’”

The majority of Pfluger’s patients successfully complete treatment within six months. She gets great satisfaction when a patient “graduates,” even though she has never met him or her in person. However, she recently had the opportunity to place a face to a voice.

“The other day, I was out shopping, and I recognized the voice of a patient I had helped care for,” she said. “This patient was working at the store. He sounded and looked so healthy, and that was great to see. To protect his privacy, I made sure I didn’t talk. I just smiled.”

photo of Guillermo Villegas
Guillermo Villegas, licensed clinical social worker at Kaiser Permanente’s mental health clinic in San Bernardino, California

Meeting patients ‘where they are’

Guillermo Villegas spends his days doing what he has wanted to do since high school: Help people in need.

“I had a friend whose dad was a social worker, and seeing the impact he had on people’s lives inspired me,” he said. “I wanted to make a difference for people.”

Villegas is a licensed clinical social worker who provides therapy services at Kaiser Permanente’s mental health clinic in San Bernardino, California. As with all of the organization’s mental health providers, the difference he makes every day comes in many forms.

Sometimes it’s helping someone overcome the emotional challenges presented by everyday life, and sometimes it’s helping someone deal with the kind of trauma that no one should have to go through.

December 2015 was one of those times. The clinic where Villegas works is located just a mile from the Inland Regional Center where a terrorist shooting killed 14 people, left 22 others seriously injured, and traumatized many, many more. As an organization, Kaiser Permanente stepped up to make sure that people who needed it had access to mental health services. Villegas was on the front lines of that effort.

“We had an influx of people who were directly and indirectly affected by that awful event,” he said. “When you are dealing with something like that, as a therapist, you have to remember that even though so many people were affected, each one has specific needs. Some want to talk about it a lot, and others don’t, and we don’t want to make them revisit their trauma. You have to meet them where they are emotionally.”

Meeting people “where they are” includes helping, in rare occasions, patients who don’t necessarily even want to be in therapy.

“We see adolescents, both in individual and in group therapy,” Villegas said. “Sometimes they are there because their parents want them there, not because they want to be there. We try to motivate them by finding out what they do want to talk about, and by letting them have a choice in the kind of therapy services they receive. Empowering young people in their own care can really help produce positive results.”

Villegas serves patients in many different ways, including conducting intake interviews, leading group therapy and teaching classes. In the last year, he has added another aspect to the care he provides: video visits.

“I do video visits for patients who may be struggling with conditions that make it difficult for them to come into the office,” he said. “It’s very satisfying to be able to connect with patients who need that kind of accommodation. That’s another example of meeting their needs with the right tools and the right approach so we can provide them the care they need.”


For additional information about how to identify signs of depression in teens, go to Kaiser Permanente is partnering with the National Alliance on Mental Illness (NAMI) to promote the importance of mental health care. We invite you to share the cause through your social media channels using #findyourwords and #intomentalhealth, NAMI’s hashtag for Mental Health Month.