Fostering Sustainable, Integrated Medical and Behavioral Health Services in Medical Settings

Abstract

The integration of behavioral health (BH) and primary care services has been the subject of considerable attention for almost a decade. Such work has been motivated by the prevalence of chronic health problems in persons with BH conditions and correspondingly high rates of early death. Service integration efforts typically included cross-referral or bidirectional efforts to add some features of primary care to specialty BH settings or the reverse. This article proposes a third approach based on full service and financial integration and shows how it differs substantially from the other 2 models. This new model has the potential to bring much-needed BH services to persons served in primary care settings who have these conditions, while fostering integrated services in specialty settings for those with the most severe mental or substance use conditions. The Patient Protection and Affordable Care Act could provide a valuable opportunity to implement this third model.

Integrating Primary Care and Behavioral Health: A Nurse Practitioner’s

“…The PCI program’s model of integration, like many other integration programs, involved “artificially [inserting]” services to make a cross-disciplinary team (Manderscheid and Kathol, 2014, 62); yet in our case, this approach led to culture clashes, different expectations and priorities, and misunderstandings. Although the PCI program’s PC and BH services were co-located in the same building, even being on a different floor created a separation and perpetuation of an “us versus them” mentality, which caused coordinated care to suffer as a result.…”

What is integrated care?

“…Improving access to medical care for BH patients seen in the BH sector is most commonly attempted utilizing the cross-referral and bidirectional models (Manderscheid & Kathol, 2014). Neither model successfully accomplishes its goals.…”

“…Finally, it is important to consider how the traditional medical versus BH payment system contributes to fragmentation of medical and BH care (Manderscheid & Kathol, 2014). For instance, (1) most behavioural health records are currently stored in non-communicating systems, (2) insurance is purchased through vendors competing to maximize profi ts on the same patients, (3) providers practice in disparate locations, and (4) laws and regulations frustrate the need for and desire of medical and BH clinicians to communicate directly with each other to solve patients ' health problems.…”

“…Transition to integrated payment needs to parallel transition to integrated service delivery (Manderscheid & Kathol, 2014).…”

Integrated Care: A Disruptive Innovation for Extending Psychiatric Expertise to Primary Care Practices

“…Kathol et al 23 argue that models of integrated care that embed behavioral health professionals with expertise in evidence-based therapies ensure improved clinical outcomes. A blend of models 24 may be needed in practice to ensure the success of integrated care in primary care. Nevertheless, the evaluation of the DIAMOND study demonstrates difficulty in translating evidence into practice despite the support of insurance companies to use bundled payments.…”