When MH Care Is Isolated, Serious Sequelae Result
Integrating physical and mental health services improves health outcomes and consumer satisfaction and promotes efficiency in health care financing.
That's the message in a new report by the Bazelon Center for Mental Health Law titled “Get It Together: How to Integrate Physical and Mental Health Care for People With Serious Mental Disorders.”
“The wall between physical and mental health care perpetuates a public health crisis,” said Chris Koyanagi, author of the report and policy director at the Bazelon Center for Mental Health Law, an advocacy group for people with mental disabilities based in Washington, D.C.
“The lack of integration can leave chronic medical conditions undetected and lead to higher health care costs and needless suffering,” she emphasized.
The Bazelon Center report lists barriers to integration of services and outlines four models for integration in programs around the country. These models include:
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The embedding of primary care providers within public mental health programs.
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Unified programs that offer mental health and physical health care through one administrative entity.
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Initiatives to improve collaboration between independent, office-based primary care and public mental health.
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Co-location of behavioral health providers in primary care offices.
The first three are cited as models to integrate care for people with serious mental illness. The fourth, co-location, is best used for integration of services to consumers with mild to moderate mental illnesses; these people are seen mostly in primary care settings, according to the report.
The report also spells out policy initiatives for service delivery, financing, monitoring, and quality assurance that public health and mental health systems can adopt to nurture integration of services through each of the models.
Among the recommended initiatives are
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Providing start-up funds for establishment of embedded or unified programs to cover clinical and administrative needs. These monies could be provided by the public mental health authority or sought from foundations, businesses, government, and health care agencies.
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Stipulating the requirements that mental health agencies furnishing on-site primary care must meet—requirements related to delivery of care, development of a unified plan of care, information sharing, and case-management services.
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Ensuring that reimbursement rates reflect the cost of providing services and the time spent on care coordination for individuals with serious mental illnesses and co-occurring physical disorders.
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Placing the responsibility for providing primary care services to those with serious mental illness clearly on one entity.
APA President-elect Steven Sharfstein, M.D., said the report underscores what psychiatrists have long known.
“Mind and body are one,” he said. “Psychiatric physicians have always known that it is essential to bring mental disorders and other medical conditions together in primary care, the acute hospital, and across specialty settings.
“The Bazelon Center report has it right,” Sharfstein said.“ An essential step in integrating mental disorders with all medical conditions is parity of insurance coverage. Another is bringing mental health specialists together with medical and surgical specialists. Integrating substance use disorders with all other mental disorders is another urgent priority. We have a long way to go.”
An executive summary of “Get It Together” is posted online at<www.bazelon.org/integration>. The full report can be purchased online at<http://store.bazelon.org>.▪
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Published online: 3 September 2004
Published in print: September 3, 2004
Notes
The lack of integration of physical and mental health care can leave chronic medical conditions undetected and lead to higher health care costs and needless suffering.
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