Alexander Papp, MD, ABPN | Julie Myers, PsyD, MSCP | Ariane Myers, PhD

Collaborative Care for Mental Health

What is collaborative care?

Collaborative care in mental health treatment refers to a model in which a psychiatrist and a psychologist coordinate directly on a patient’s care, rather than working independently. This approach combines medication management with psychotherapy, allowing both providers to share clinical information and adjust treatment in response to the patient’s progress. Research indicates that combined treatment of this kind outperforms either medication or psychotherapy alone for many psychiatric conditions

How Does It Works at Point Loma Clinic?

Point Loma Clinic integrates psychiatry, psychotherapy, and (if indicated) ketamine treatment within a single practice. Dr. Papp and Dr. Myers have worked together in this model for over a decade at the Point Loma Clinic, and before that they worked in other clinical settings with a coordinated approach. Patients who have received care elsewhere often notice the difference immediately — a clinical environment in which their providers are in frequent communication and decisions are not made in isolation.

When more than one of our providers is involved in your care, between-session consultation happens frequently — conversations about how a medication adjustment may be interacting with what is arising in therapy, whether a new symptom warrants a different approach, or whether a family member’s involvement would shift the treatment picture. Clinical decisions are rarely made in isolation. More extended discussions about patient care are common, especially for more complex presentations. (We do not charge for any of these in-house consultations.)

Why Combined Treatment Outperforms Either Alone

The practical barrier to combined treatment is coordination. When a prescriber and a therapist work in separate practices, communication is limited, delayed, or absent. At Point Loma Clinic, that barrier does not exist.

Pharmacotherapy and psychotherapy address different dimensions of psychiatric illness. Medications act on the biological substrates of symptoms — neurotransmitter systems, sleep architecture, arousal regulation. Psychotherapy targets the cognitive, behavioral, and relational patterns that sustain those symptoms and determine long-term functioning. One meta-analysis of 153 trials found that combined treatment outperformed either modality alone on both symptom severity and quality of life.(Lemmens LH, et al., 2019)

When Coordinated Care Is Most Useful

Not every patient needs more than one provider, and it is always up to the patient to decide if they want that option. Coordinated care tends to be most valuable in the following situations:

Acute or severe illness. Decisions about medication changes, level of care, and therapeutic focus are better made with shared information than independently.
Cognitive or intellectual limitations. When a patient’s capacity to self-monitor or accurately report symptoms is reduced, multiple clinicians tracking the same case creates a more reliable picture.
Family dynamics. Whether family members are part of the problem or part of the solution, coordinating their involvement across providers produces a more coherent treatment approach.
Complex psychiatric presentations. Multiple diagnoses, treatment-resistant conditions, or comorbid substance use benefit from providers in direct communication. The perspective a therapist develops over weekly sessions often contains information directly relevant to a prescriber’s decisions — and vice versa.
Complex medical cases. Patients managing serious physical conditions alongside psychiatric ones benefit from mental health providers who understand health conditions and who can communicate actively with their medical team. All of our providers are experienced in this kind of cross-disciplinary coordination.
Monitoring between appointments. A therapist in regular contact with both the patient and the prescriber functions as an additional monitoring layer — symptom changes or side effects can be identified and communicated before the next scheduled appointment with another provider.
Ketamine treatment. Because Dr. Papp administers ketamine and Dr. Julie Myers provides follow-on psychotherapy, treatment sequencing — timed to take advantage of ketamine’s effect on neuroplasticity — can be planned and monitored with a level of coordination difficult to achieve across separate practices.
Coverage and continuity. When one provider is temporarily unavailable, a patient with an established relationship with a second provider at the clinic is not without clinical contact — and the backup is already fully informed.

Practical Advantages

Minor medication adjustments can often be handled through provider communication rather than a separate appointment, reducing the overall number of billable visits. Over time, this can meaningfully lower the cost of care. It also provides a clinical safety net: if one provider is temporarily unavailable, the clinical picture is already shared and care does not stall.

Dr. Julie Myers holds a postdoctoral Master’s degree in Clinical Psychopharmacology, which means she can engage substantively with the pharmacological dimension of your care — not merely as a referring party, but as an informed clinical voice. Questions about how a medication may be affecting mood, sleep, cognition, or therapy progress can be addressed in-house, between providers who already know your case.

Coordination Beyond the Clinic

All three providers are experienced in coordinating with physicians, specialists, and other clinicians outside the practice when a broader approach benefits the patient. Dr. Papp has worked for years in community and university clinics alongside medical teams. Dr. Julie Myers completed formal training in Integrated Primary Care and conducted practicum work in a primary care and intensive outpatient setting. Dr. Ariane Myers worked in community clinics and intensive outpatient settings. This kind of wrap-around care — where mental health providers are active participants in a broader clinical picture rather than isolated consultants — is something all three providers actively value and pursue.

Confidentiality and Consent

If you are seeing only one provider at Point Loma Clinic, strict confidentiality is maintained. Your care is not discussed with other clinic providers without your knowledge and consent. When you are seeing more than one clinician at the clinic, you can expect that they are in communication about your care.

Any communication outside the clinic — with your primary care physician, other specialists, or family members — occurs only with your explicit, written permission. Some patients prefer that their care at Point Loma Clinic remain entirely separate from other providers or personal relationships, and that preference is fully respected.

Frequently asked questions

How does coordinated care benefit the patient?

For many patients with depression, anxiety, OCD, and PTSD, the combination of medication and psychotherapy tends to produce better outcomes than either approach alone, though the degree of benefit varies by condition and individual. The practical barrier is usually coordination: when providers work independently, the potential benefit of a combined approach often fails to materialize. At Point Loma Clinic, that coordination already exists.

If I’m already seeing a psychiatrist or therapist elsewhere, can you coordinate with them?

Yes. All three providers regularly coordinate with clinicians outside the practice — primary care physicians, neurologists, other psychiatrists and therapists — when it serves the patient. Dr. Julie Myers has formal training in Integrated Primary Care and has experience coordinating with medical teams. Any communication outside the clinic requires your explicit written consent. Some patients prefer that their care at Point Loma Clinic remain entirely separate from other providers, and that preference is fully respected.

Does coordination between my providers cost extra?

No. In-house consultations between your providers are not billed. In practice, coordination often reduces cost, because minor questions and medication adjustments can sometimes be handled through provider communication rather than an additional appointment.

Will my providers share everything I tell them?

If you see only one provider at the practice, strict confidentiality applies and your care is not discussed with the others without your consent. When you choose to see more than one of our clinicians, you can expect them to communicate about certain aspects of your care, since that coordination is the point of the model. Communication with anyone outside the practice happens only with your explicit written permission.

Can my providers coordinate with clinicians outside the practice?

Yes, with your written permission. All three of our providers have experience coordinating with primary care physicians, specialists, and outside therapists, and do so when a broader clinical picture benefits your treatment.