What Is the Next Focus of Collaborative Care?

Seven years ago, I was invited to write a column in Psychiatric News on integrated care to “educate members about integrated care and raise their interest in the topic and in this practice model.” When I first started presenting about integrated care at APA meetings 20 years ago, I was speaking to mostly empty lecture halls, so a monthly column on the topic in APA’s preeminent news publication for members was a welcome and exciting opportunity. At the time, integrated care was slowly gaining traction but was still somewhat in the shadows of our profession.

Fast forward to today when nearly 4,000 psychiatrists have completed APA’s training in the Collaborative Care Model, new billing codes have been approved for collaborative care by Medicare and an increasing number of state Medicaid and commercial insurance plans, and integrated care is finding its way into psychiatry residency programs. Collaborative care is now widely regarded as an evidence-based model of care for depression, anxiety, and a number of other common psychiatric disorders in patients with and without comorbid medical disorders such as heart disease, diabetes, and cancer.

Research and real-world implementation studies of collaborative care have been carried out in a wide variety of clinical settings including primary care clinics, community health clinics, school-based clinics, and specialty care settings such as maternal and infant care programs and cancer care programs. Collaborative care has also been shown to be effective for individuals from a wide age spectrum ranging from adolescents to older adults. Collaborative care programs that are adapted for specific settings or populations continue to evolve and adapt, and some of the most recent research is applying core principles of collaborative care in the treatment of individuals with opioid use and other substance use disorders. In short, collaborative care has come a long way!

With the increasing knowledge and acceptance of collaborative care, our initial goal for this column has been met. Over the last seven years, we have had the privilege of sharing people’s experiences with integrated care in different settings and populations; profiling psychiatrists and other health care professionals who work in such programs; and sharing challenges, opportunities, and insights into this maturing field. Psychiatric News has compiled an archive of many of those columns that is a wonderful body of stories and a testament to the outstanding work that has been done.

Looking ahead, we plan to continue this column every other month but with a broader interpretation of “collaborative care.” We know that more than half of counties in the United States do not have a single practicing psychiatrist or psychologist, and the simple truth is that we will never have enough psychiatrists to meet all of the needs of our population. So we will take a good look at ways in which psychiatrists can partner with others in the health care or social services sectors to leverage our clinical expertise. What new intersections and partnerships can we step into? How can we “think outside the box” to better meet the needs of the large populations of patients who need care for a mental health or substance use problem?

I look forward to hearing about the intersections of psychiatry with the criminal justice system, juvenile justice system, schools, faith-based organizations, community-based organizations, family members of those living with mental illness, and more. Please reach out if you would like a platform to share your experience in this broader context of collaborative care.

I am grateful to the editors of Psychiatric News for being such supportive partners in this journey, and I look forward to what we can accomplish in the expanded iteration of this column on integrated and collaborative care. ■