WHAT ARE SOME BENEFITS OF INTEGRATED CARE?
Put simply, integration of services means a more cohesive service delivery system and better continuity of care. The reasons are multifold:
- Primary care community clinics are often the “first line of defense,” providing early intervention. The presence of mental health professionals leads to increase recognition of behavioral needs and disorders. What’s the evidence for this?
- Integrated behavioral care produces significant positive results, including decreases in client depression levels, improvement in quality of life, decreased stress and lower rates of psychiatric hospitalization. What’s the evidence for this?
- More people will be reached and more access afforded if behavioral care is based in primary care settings. Studies have shown that initially most people turn to primary care providers, not specialty mental health clinics, with their emotional problems. What’s the evidence for this?
- Both medical and behavioral professionals can get the “full picture” about the clients they’re treating.
- Offering behavioral health services in nontraditional settings encourages participation by people wanting to avoid the stigma surrounding mental health treatment. Studies have demonstrated possible effects of perceived stigma by showing that clients are less likely to follow up on referrals made to mental health settings than they are to in-house services. What’s the evidence for this?
- Clients like the convenience of “one-stop shopping”. Whether their problem is emotional or physical, they can feel that they’ve come to the right place.
- Many clients transfer the trust and rapport they share with their physicians to the behavioral specialist he or she designates.
- Clinics are often easier to access than mental health facilities. What’s the evidence for this?
- Some studies indicate that integrated care leads to a reduction of inappropriate use of medical services and a cost-savings in big-ticket items like emergency room visits and hospitalization. What’s the evidence for this?
- By referring clients with mental health issues to those specially trained to deal with them, physicians free up their time up to handle more medically-oriented problems.
- Physicians report increased satisfaction when they have easily available back-up care for their clients’ mental health needs. What’s the evidence for this?
- The physicians’ knowledge, skill-sets and comfort-zone are expanded as a result of collaboration with mental health professionals. What’s the evidence for this?
- Studies have shown increased client compliance with medical regimens like diet and smoking cessation when behavioralists provide training and guidance. What’s the evidence for this?
- Management of emotional/behavioral disorders may positively impact adherence to treatment of physical disorders. What’s the evidence for this?
- There are often better mental health outcomes when physical problems are managed. What’s the evidence for this?
- In a general care atmosphere, terms like “psychiatric problems” and “mental illness” can be replaced by more universal, less stigma-laden terminology, like “coping skills”, “counseling” and “stress”.
- The primary care network serves a primarily poor and underserved population. What’s the evidence for this?
- The primary care network is a main provider of services to minority populations and culturally diverse communities. What’s the evidence for this?
- Primary care providers have been shown to have a high level of client adherence and retention in treatment. What’s the evidence for this?
Barbara Mauer, in the background paper she prepared for the National Council for Community Behavioral Healthcare entitled "Behavioral Health/Primary Care Integration Models, Competencies and Infastructure" (May 2003) laid out reasons why states, counties and individual primary care clinics should undertake integrated care:
- Because many people in the broader community now receive their behavioral healthcare in a primary care setting, and the gap between medical and behavioral healthcare systems must be bridged.
- Because there is the opportunity for quality improvement of care within the primary care and specialty behavioral healthcare settings.
- Because many people being served by public behavioral health services need better access to primary care.
- Because community health centers serve people who need better access to behavioral healthcare.
- Because behavioral health clinicians are a resource for assisting people with all types of chronic health conditions.
- Because there are changes underway in the financing of both healthcare and behavioral healthcare systems.
- Because it's the right thing to do.
More specific reasons are also found in this document:
- Half of the individuals who receive mental health care seek services from a primary care or a family practice physician.
- Psychosocial stress is a major factor in triggering physical illness and exacerbating existing chronic illnesses.
- Many individuals seeking medical services report symptoms that may be psychosomatic, i.e., physical complaints without an identifiable medical basis. In these instances, an underlying behavioral or emotional condition can increase unnecessary medical utilization, and the client is often not referred to appropriate treatment.
- Many primary care physicians - faced with increased administrative demands and time constraints - are ill-equipped to manage patients who present with mental health or substance abuse related issues.
- Subclinical and clinical depression is frequently misdiagnosed or underdiagnosed in general medical populations.
- Substance abuse problems often go unrecognized but trigger or exacerbate conditions such as accident-related injuries, gastritis, diabetes and hypertension, liver abnormalities and cardiac problems.
- Depression is a frequent complication of cancer, post-cardiac surgery, diabetes, post-partum, and in the treatment of any chronic and debilitating physical illness.
- Emotional factors are thought to play a role in triggering asthma attacks and exacerbations of autoimmune diseases (lupus, sarcoidosis, multiple sclerosis).
- Depression and substance abuse screening and referral are essential components in a primary care setting. However, medical staff has little time or expertise available to perform these functions.
- Group-oriented behavioral interventions have been found useful in addressing emotional factors in chronic and acute disease, improving adherence to medical regimens.
For a more in-depth discussion of each of these reasons, go to "Behavioral Health/Primary Care Integration Models, Competencies and Infastructure". A summary of collaborative care advantages can also be found in "The Case for Treating the Whole Person in the Age of Health Care Reform: Lessons Learned from the Integrated Behavioral Health Project" (2011).