Reflections on ‘Psychiatry & Integrated Care’

Last month marked the five-year anniversary of this column, “Psychiatry & Integrated Care,” and I’d like to use it as an opportunity to reflect on the tremendous amount of work being done in this space and to thank the numerous authors who have contributed their thoughts and expertise. This is one of the longest-running columns in Psychiatric News, which speaks to the growing interest and excitement about integrated care as a way for psychiatry to help more people in need.

In my inaugural column, I wrote about the fact that the vast majority of Americans living with mental health and substance use conditions will not see a psychiatrist in any given year and that we will probably never have enough psychiatrists to meet the mental health needs of all Americans. Every column since then has highlighted programs and people in the United States and around the world who are working to leverage the mental health professionals we do have to increase access to effective mental health care through collaborations with our colleagues in primary care, school-based mental health programs, and other opportunities to serve populations who have limited access to specialty mental health care today.

Some authors have written about how integrated care is bringing better mental health care to people with a wide range of conditions including depression, anxiety, bipolar disorder, posttraumatic stress disorder, cancer, chronic pain, alcohol use disorder, and, more recently, opioid use disorder. Other authors have highlighted innovative integrated care programs that are benefiting particular populations such as veterans, children and adolescents, and pregnant and new moms. We’ve learned about residency programs that are embracing a population-level approach to mental health care and innovative ways to extend our reach and impact such as telepsychiatry, task sharing, using “big data,” and modifying evidence-based behavioral interventions for use in primary care.

We’ve written about some important historical landmarks including the creation of Current Procedural Terminology (CPT) codes that allow primary care practices to bill for collaborative care in partnership with a psychiatric consultant and APA’s massive effort to train 3,000 psychiatrists across the United States in collaborative care. Mental health is a critical piece of the ongoing dialogue surrounding health care reform, and several authors have spoken to the need to examine old ways of doing things to make systemwide changes in virtually every setting we work including community mental health centers, primary care settings, schools, and the justice system. This column has highlighted the critical and evolving role and opportunities for psychiatrists in health care reform and will continue to bring in voices that challenge us to think outside the box.

Some of my favorite columns have been personal essays that artfully explained why the author chose to practice in integrated care, what he or she has learned, and how diversifying one’s practice by being on an integrated care team has helped ward off burnout and returned joy to the practice of psychiatry. I’ve especially appreciated the perspectives given by people outside our discipline such as primary care providers and behavioral health consultants, and I hope to bring more of those voices into this column in the coming years. I’ve also appreciated hearing about programs based outside the United States such as the terrific work being done in the U.K., Canada, Nepal, and elsewhere, and we will continue to share these international perspectives.

This column was also the platform where we acknowledged the passing of Wayne Katon, M.D., a mentor to so many of us and a pioneer in adapting the chronic care model to depression and other common mental disorders. I asked Wayne to write one of the first articles in this column about his three decades of work in integrated care, which provided a rich history and background to all of the work currently being done. I know that Wayne would be proud of his legacy and the stories we have collectively shared in this space.

As our field matures, we hope to use this column to continue to share people’s experiences with integrated care in different settings and populations; profile psychiatrists and other health care professionals who work in such programs; and share challenges, opportunities, and insights into this emerging field. Please continue to reach out to me if you would like a platform to share your experience.  ■