Integrated-Care Models Increase Psychiatrists’ Impact

If psychiatrists want to be more effective and help a much larger number of people, they need to work in a model of integrated care where they can collaborate closely with primary care physicians, said psychiatrist Jürgen Unützer, M.D., M.P.H., at APA’s 2012 Institute on Psychiatric Services in New York last month.

An internationally known psychiatrist and health services researcher and director of the AIMS Center (Advancing Integrated Mental Health Solutions) at the University of Washington, Unützer described innovative models of care that integrate mental health and general medical services. He presented evidence that psychiatrists working in a consultative way with primary care can significantly improve mental health care for large populations of people in primary care, while also lowering overall health care costs.

“In a collaborative-care model, we as psychiatrists can help our colleagues in primary care make a big difference and improve the lives of the patients they are seeing,” Unützer said.

Unützer’s presentation, titled “Integrated Behavioral Health Care: Closing the Gap Between What We Know and What We Do,” was part of the institute’s integrated-care track that included more than 20 presentations about what is a rapidly developing sub-specialty area. Integrated or collaborative care is a feature of the delivery-system reforms in the health care reform law, and policymakers and many clinicians have converged on the idea that the full range of medical services should be brought together in one patient-centered location.

Unützer said that for psychiatrists, the need for a better model of care is based on three essential facts: most patients with mental health problems do not see a psychiatrist, and primary care serves as the “de facto” system of mental health care; mental disorders are rarely the only health problem of people seen in primary care settings, and they are complicated by multiple acute and chronic medical conditions; and the current system offers poor coordination of primary care, specialty mental health care, substance abuse services, and community-based and social-service systems.

He cited findings from the National Comorbidity Survey Replication published in the June 2005 Archives of General Psychiatry showing that among people living with a DSM-diagnosed mental illness in the community, only 41 percent had gotten care and had had any contact with a mental health professional.

“If you look specifically at how many saw a psychiatrist, it’s about 12 percent,” he said. “That’s a big challenge to me as a psychiatrist…. I think we are a small part of the answer, and if we don’t find other ways to reach people with mental health problems, we are going to be considered irrelevant.”