Integrated Care Refresh, Part 2: Reverse Integration of Care and Integrated Care in the Inpatient Setting

This second installment of a double collection on Integrated Care focuses on models that strive to improve care and health outcomes for people with serious mental illness. Integration of behavioral health in primary care settings, highlighted in Part 1, most often focuses on the care of people with mild to moderate behavioral health problems. People with serious mental illness face glaring health disparities and decreased life expectancy, largely due to comorbid general medical conditions, and often primarily receive services in specialty mental health settings. Efforts to integrate behavioral health and general medical care for people with serious mental illness seek to address treatment barriers resulting from historically siloed health care systems and bring general medical care to behavioral health settings. These integrated strategies aim to improve access to care, strengthen communication and coordination between providers, and tailor services and build expertise in the care of people with general medical and psychiatric comorbidities.

In this collection, the first set of articles explores the reverse integration of medical care into behavioral health settings. Authors highlight behavioral health homes and other specialty mental health system–based integrated care models, including the incorporation of primary care and cardiometabolic screening into assertive community treatment. The second group of articles features integration of care in the inpatient setting. Authors describe integrated inpatient medical and psychiatric units, advocate for an evidence-based practice approach to evaluating medical-psychiatric units, and describe person-centered approaches to discharge planning for people with serious mental illness. Together, integrated behavioral health in primary care settings, reverse integration in behavioral health settings, and inpatient integrated care models for people with serious medical as well as psychiatric illnesses represent a continued movement toward more comprehensive, person-centered care with the goal to improve health outcomes and care delivery.