Table 5 Themes regarding incorporation of in-person support to address mental health in the orthopedic care setting

Feasibility

Skepticism: Many orthopedic clinicians questioned the financial and logistical feasibility of in-person support from a mental health specialist within the orthopedic clinical environment.

“I think [a counselor or social worker] would be very helpful, but I don’t see it happening in this day and age in healthcare.” (Physician)

“I don’t think there are enough patients, at least in my practice, to make it work out.” (Physician)

Acceptability

Ideal for some patients: Orthopedic clinicians, clinical support staff, and patients expressed that a subset of patients require and prefer one-on-one in-person mental health support.

“I think in-person options are going to be the key. Handouts are great, but then they’re like, ‘Okay, now what? Are you going to schedule me with somebody? Is there somebody I can talk to? If you can’t help me, who’s going to help me? My primary care provider doesn’t want to deal with this. What do I do now? This isn’t a pain management doctor problem. So now what do I do?’” (Medical assistant)

“For a lot of patients, I’ve told them that they need to see or try to find a psychiatrist, but they always have trouble finding one.” (Physician)

“I think it would be awesome to have a therapist that will come in and speak to you for maybe five, ten minutes that can give pointers, things that you can do to help, say, if a person needs it.” (Patient, 35-year-old Black woman)

“I like to see them face to face. I like to have the interaction where you can see my face. You could follow up with a phone call or a computer, but initially I would like to have a face, a Zoom call, or something so you could see the expression on my face.” (Patient, 71-year-old Black woman)

Considerations for various care models: Orthopedic clinicians proposed various models to integrate in-person mental health support into the orthopedic care plan. Compared to orthopedic teams that care for relatively acute and correctable conditions, clinicians and support staff who predominantly care for patients with chronic conditions, spine conditions, and/or life-altering (e.g., major traumatic or oncologic) conditions more frequently expressed that a departmental social worker or counselor would be an important resource, as opposed to referral to an outside resource.

“There are a couple applications for social workers that I think would be helpful. One would be mental health counseling. The other is for patients that are uninsured or underinsured to give them resources and help with things. So, I think there’s utility for multiple roles that someone like a social worker can play, and I think that would be very beneficial. It can be one [social worker] at each clinical location. We’re not asking them to take on all of our patients. It’s a subset for sure.” (Physician)

“Just a list of names of people that maybe we have a relationship with – a psychiatrist that maybe we can refer them to would be nice. Maybe forming some relationships with some psychiatrists. I think that, and then maybe some psychologists, as well.” (Physician)

“I think it depends on the clinic. I mean, maybe in some ways you could consider having a ‘complex patient’ clinic and have more resources available there. Have longer appointment times, more resources available – like a psychologist or psychiatrist – at those visits.” (Physician)