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Integration of Behavioral and Medical Health

 More and more each day we hear about integrating behavioral health with the medical community. The most obvious way to do this is by co-locating behavioral health into primary care physician’s offices.  The United States continues to deliver highly fragmented, inefficient, and expensive care (Eugene S. Farley, Jr. Health Policy Center) and this ineffective care came under scrutiny during President Obama’s administration. With the Affordable Care Act came a drive to ensure patients receive quality care and the medical community was incentivized to reduce their costs to patients and insurance companies.  The need for integrated care emerged.

              In the past we divided the fields of medicine and behavioral health until recent studies began to show evidence that the two not only relate but influence each other. In fact, nearly half of adults (46%) and 28 percent of children can be expected to experience a mental health illness or substance abuse disorder during their lives (Kessler, Wang, and Merikangas, He, Burstein, et al).  These figures highlight the need for integrating behavioral health into the primary care setting.  66 percent of primary care providers report being unable to connect their patients with appropriate follow-up resources because of a shortage of mental health clinicians and health insurance barriers (Cunningham).  The American population generally seeks help from primary care physicians first. This route was established by the medical community as a starting point and has been accepted by most Americans because of convenience and availability.  

              Patients want to see a provider they are comfortable with, in a location that is convenient for them, and that doesn’t have a stigma attached to seeking help. While it is hard for people to get past the social barrier of visiting a mental health clinic there is no social stigma attached to visiting a primary care physician’s office. Having a primary care physician issue a warm introduction to a behavioral health worker in their office and handing them off in the same office increases the likelihood that the patient will follow through with getting the help he/she needs. Client no show rates have been shown to significantly decrease after the physician personally hands off the patient to the behavioral health care worker.  

              More than 75 trials of integrated approaches to care show significant clinical benefits in depression and anxiety (Archer, Bower, et al). In one five-year, federally funded study, researchers observed that medical use decreased 15.7 percent among those who received integrated behavioral health treatments, while it increased 12.3 percent among those who did not (Archer, Bower, et al). Multiple research studies have been conducted and there is evidence proving the value. The problem lies with getting the therapist and psychologist on the same team with the physicians. We as American’s need to demand of our representatives in Washington that they work together with the medical field, insurance companies, and behavioral health personnel to create a positive culture of health for our nation. A nation that values what is best for both our physical and mental health.

 

References:

Eugene S. Farley, Jr. Heath Policy Center, Robert Wood Johnson Foundation. Integrating Behavioral Health and Primary Care, An Actionable Framework For Advancing Integrated Care. February 2016.

Kessler RC, Wang PS. The descriptive epidemiology of commonly occurring mental disorders in the United States. Annu Rev Public Health. 2008 Apr 21;29:115-29.

Merikangas KR, He JP, Burstein M, Swanson, SA, Avenevoli S, Cui L, Benjet C, Georgiages K, Swendsen J. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication – Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry. 2010 Oct 31;49 (10):980-9.

Cunningham PJ. Beyond parity: primary care physician’s perspectives on access to mental health care. Heath Affairs. 2009 May 1:28 (3): w490-501.

Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev. 2012 Oct:10 (10).

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