Chapter 38.Integrated and Collaborative Care

Mental disorders are responsible for significant morbidity and mortality, accounting for about 25% of disability worldwide (Murray et al. 2012). However, in the United States, only 12% of people with psychiatric disorders see a psychiatrist, and only 21% see any mental health specialist (Wang et al. 2005). Most people do not seek any medical care, and of those who do, more than half are seen in general medical settings, which have a low rate of adequate mental health care (Unützer and Ratzliff 2015). Access to specialty mental health care is poor, and only about half of the patients referred from primary care to specialty mental health care follow through with the referral (Grembowski et al. 2002). At the same time, patients with chronic severe mental illness have shorter life spans and higher rates of chronic medical conditions, primarily as a result of socioeconomic factors, side effects of psychotropic medications, and limited access to effective primary and preventive health care (Druss et al. 2011). These gaps in access to and quality of care have led to efforts to integrate behavioral and general medical services so as to improve both mental health and medical outcomes for patients.