Improving the Reach and Effectiveness of Integrated Care

It has been two years since I began editing this column on integrated care, and I suspect many readers are familiar with the broad themes associated with this new approach. Integrated care effectively incorporates good mental health care with the rest of health care, leveraging psychiatrists and other mental health specialists to reach more patients in need. The Centers for Medicare and Medicaid Services and other major health care payers are considering establishing new payment methods for evidence-based collaborative care, and this could dramatically increase access to this effective model of care over the next few years. To realize this opportunity, we will need to dramatically expand the availability of psychiatrists and other mental health care professionals who are trained in evidence-based collaborative care. We also need to continue to look for new ways to leverage the skills of psychiatric consultants to reach more people in need.

One of the most promising approaches to further improve the reach and effectiveness of behavioral health care is the systematic involvement of family members, peers, community health workers, and community-based organizations in care. The ability to share some of the important tasks of evidence-based collaborative care with family members, peers, or community health workers has the potential to dramatically increase access to high-quality treatment and to effectively leverage mental health services provided in primary care and other health care settings.

Examples of such task sharing include the award-winning Center for Health Services and Society, which works to improve depression care across diverse health care and community programs in Los Angeles. The center was pioneered by Ken Wells and colleagues at UCLA.

In a similar effort and with support from the Archstone Foundation’s Late-Life Initiative, researchers at the University of Washington and the University of California, Davis, are testing ways to expand collaborative primary care for depressed older adults by engaging family members or health workers in community-based organizations in care teams. For example, Ladson Hinton, M.D., a professor and director of geriatric psychiatry, is leading an effort to implement a family partnership intervention at the McClellan Outpatient Clinic, a clinic of the U.S. Department of Veterans Affairs.

Another promising approach to improve the reach and effectiveness of integrated behavioral health care is through the use of technology. Mobile technologies, such as smartphone apps, can allow patients to check in and communicate with their collaborative care team at any time. In addition to facilitating efficient check-ins, such apps can provide timely reminders and information to help patients, family members, and caregivers understand their conditions and tools for taking good care of themselves and their loved ones.

Technology can also be used to help deliver evidence-based psychosocial treatments such as problem-solving treatment (PST) to patients in home and community settings. For example, in the Bridging Research Innovations in Greater Health through Technology, Emotion, and Neuroscience Study (BRIGHTEN), over 1,000 people received app-based mental health care in the course of five months, including iPST, an app based on basic problem-solving therapy. After two weeks of regular use, participants showed marked improvement in mood and self-reported function. The VA’s Moving Forward program is also based on basic PST principles, offering returning veterans web-based and app-based interventions to help them reintegrate into society.

The field of integrated care is young, and there is still much work to do if we want to better leverage the skills of psychiatrists to reach the millions of individuals who are suffering from untreated mental health and substance use problems each year. New partnerships and new technologies are offering us important opportunities to reach this ambitious goal. ■