Resources - Integrated Health Care
An Integration of Mental Health Services and Primary Health Care
What is Integrated Health Care?
Integrated health care is a system of health care in which both mental and physical problems and disorders are treated simultaneously. It is a system that recognizes that a mental disorder must be treated with equal importance as a physical disorder. President Bush's New Freedom Commission Report on Mental Health reinforces this idea:
"Understanding that mental health is essential to overall health is fundamental for establishing a health system that treats mental illnesses with the same urgency as it treats physical illnesses."
In order to properly treat individuals with mental disorders we must pay closer attention to how the mental and general medical care systems can work together. It is clear that mental and physical health are connected, and with a transformed system in which both care systems collaborate for care, we can bridge the gap that currently exists between these two systems. Under an integrated health care system, effective mental health treatments will be available for most mental disorders, and primary care providers will have the necessary time, training and resources to appropriately treat mental health problems and have access to mental health specialists when it is necessary to make a referral.
Why is Integrated Health Care Important?
- Every year, about 20% of the U.S. adults and children have a mental disorder.
- Mental disorders are highly disabling, ranking second only to cardiovascular conditions as a leading cause of worldwide disability.
- Despite having many known treatments, the majority of individuals with mental disorders do not receive proper treatment.
- The prevalence of mental disorders in primary care is higher than that in the population. About 25% of individuals receiving primary care also have a diagnosable mental disorder.
- Mental disorders frequently co-occur with other mental or physical disorders.
- Many persons resist diagnosis and treatment of mental disorders because of the overwhelming societal stigma on mental illness.
- Primary care providers who are able to correctly diagnose a mental disorder may not adequately treat and monitor the person.
- Estimates state that approximately half of those with mental disorders go undiagnosed in primary care.
- Despite its current deficiencies, primary care has great potential to engage individuals in need of mental health care
- The primary care provider is often closer to home or work and more affordable than specialty care and could provide cost-effective treatment, especially for less severe mental disorders.
- Primary care has the potential for early identification of symptoms of mental disorders.
- MENTAL HEALTH IS FUNDAMENTAL TO OVERALL HEALTH! Mental health and physical health are interdependent and therefore should be treated in an interdependent health care system.
Total Well-Being
For people who live with mental illnesses, a healthy lifestyle is especially important. Sometimes, it is easy to become so focused on treating a mental illness that physical health is neglected. But having a healthy body contributes to emotional recovery. Eating the right foods, exercising, finding ways to manage stress, getting enough rest and having friends and activities that you enjoy are all part of healthy living. It can help you make better choices for yourself, develop new interests and even make new friends and acquaintances, leading to a happier, more fulfilling life. Review information about the importance of physical health in conjunction with mental health, and for access to the Hearts and Minds booklet created by NAMI - Hearts and Minds.
Depression: The Mind Body Connection
Research has shown that having depression can affect other physical illnesses such as diabetes, HIV, cancer, and heart disease. Having depression can make these, and other illnesses more frequent, severe and difficult to treat. If depression is untreated, many illnesses can worsen. So, treating depression can help individuals manage physical illness and improve their general health.
Symptoms of Depression
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feels of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide or suicide attempts
- Restlessness, irritability
If five or more of these symptoms are present every day for at least two weeks and interfere with routine daily activities such as work, self-care, and childcare or social life, seek an evaluation for depression.
Depression and Cancer
"Research has enabled many men, women and young people with cancer to survive and to lead fuller, more productive lives, both while they are undergoing treatment, and afterwards. As with other serious illnesses, such as HIV, heart disease or stroke, cancer can be accompanied by depression, which can affect mind, mood, body and behavior. Treatment for depression helps people manage both diseases, thus enhancing survival and quality of life." Review NIMH - Depression and Cancer
Depression and Diabetes
"Depression can strike anyone, but people with diabetes, a serious disorder that afflicts an estimate 16 million Americans, may be at greater risk. In addition, individuals with depression may be at greater risk for developing diabetes. Treatment for depression helps people manage symptoms of both diseases, thus improving quality of life." Review NIMH - Depression and Diabetes
Depression and Heart Disease
"Depression can strike anyone. However, research over the past two decades has shown that people with heart disease are more likely to suffer from depression than otherwise healthy people, and conversely, that people with depression are at greater risk for developing heart disease. Furthermore, people with heart disease who are who are depressed have an increased risk of death after a heart attack compared to those who are not depressed. Depression may make it harder to take the medications needed and to carry out the treatment for heart disease. Treatment for depression helps people manage both diseases, thus enhancing survival and quality of life." Review NIMH - Depression and Heart Disease
Depression and HIV/AIDS
"Research has enabled many men and women, and young people living with human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS), to lead fuller, more productive lives. As with other serious illnesses such as cancer, heart disease or stroke, however, HIV often can be accompanied by depression, an illness that can affect mind, mood, body, and behavior. Treatment for depression helps people manage both diseases, thus enhancing survival and quality of life." For more information, review NIMH - Depression and HIV/AIDS
Depression and Stroke
"Depression can strike anyone, but people with serious illnesses such as stroke may be at greater risk. Appropriate diagnosis and treatment of depression may bring substantial benefits to persons recovering from a stroke by improving their medical status, enhancing their quality of life, and reducing their pain and disability. Treatment for depression also can shorten the rehabilitation process, lead to more rapid recovery and resumption of routine, and save health care costs (e.g., eliminate nursing home expenses)." To read more, please review NIMH - Depression and Stroke
The Collaborative Family Approach to Healthcare
"The collaborative family healthcare model envisions seamless collaboration between psychosocial, biomedical, nursing, and other healthcare providers, and views patient, family, community, and provider systems as equal participants in the healthcare process. This approach is a radical departure from conventional "diagnose and refer" models and is distinctly different from the usual managed care approaches. It recognizes that clinical events always occur at biological, psychological and social levels, and that patient, family, and community represent a single ecosystem. By adding the essential ingredients of psychological and family care at the front end, and continuously throughout the healthcare process, and by coordinating and integrating the hard-won expertise of these and other healthcare professions, the wasteful use of repeated diagnostic procedures is minimized, as are costly sub-specialty referrals. It is a profoundly ethical approach that conserves resources for all participants: patients and their families, clinical providers, administrative and financial entities ." For more information, review Collaborative Family Healthcare Association
The President's New Freedom Commission on Mental Health
On April 29, 2002 the President of the United States announced the creation of the New Freedom Commission on Mental Health. He declared, " Our country must make a commitment. Americans with mental illness deserve our understanding and they deserve excellent care." The initiative of the Commission was to focus on three obstacles, identified by the president, which prevent individuals with mental illnesses from getting proper care. These obstacles are:
- Stigma that surrounds mental illnesses,
- Unfair treatment limitations and financial requirements place on mental health benefits in private health insurance, and
- The fragmented mental health delivery system.
The members of the Commission were directed to study the problems and gaps in the mental health care system and to make recommendations for improvements that could be implemented by the Federal and State governments, local agencies, and public and private health care providers. Based on the research it conducted, the Commission created six goals for a transformed Mental Health System.
Goals:
- Americans understand that mental health is essential to overall health.
- Mental health care is consumer and family driven.
- Disparities in mental health services are eliminated.
- Early mental health screening, assessment, and referral to services are common practice.
- Excellent mental health care is delivered and research is accelerated.
- Technology is used to access mental health care and information.
It is through the realization of these goals that Americans will find a transformed system of mental health.
Recommendations by the New Freedom Commission on Mental Health Care on the Integration of Mental health and General Medicine
In order to create an effective delivery system of treatments for mental disorders the barriers between the patient, the provider and the medical system must be eliminated. Below are the necessary components for improving care for common mental disorders (Excerpt from Mental Health Today):
- Educated consumers, primary care providers and mental health providers
- Efficient and effective methods to screen for, diagnose, and monitor common mental disorders in primary care
- Information systems that can support proactive tracking of quality and outcomes of care by primary care and specialty mental health providers in order to prevent patients from "falling through the cracks"
- Well-established performance criteria for quality of mental health care at the interface of general medicine and mental health
- Evidence-based, collaborative and stepped care treatment protocols that match treatment intensity to clinical outcomes
- Trained mental health staff (psychiatrists, psychologists, clinical social workers, or other mental health workers) who can support primary care providers with education, proactive follow-up, case management, psychotherapy, and consultation for patients who do not respond to first-line treatments in primary care
- Effective mechanisms for evidence-based models of care for common mental disorders in primary care. This includes payment for case-management for common mental disorders in primary care according to evidence-based protocols, consultation to primary care providers and supervision of mental health case managers by qualified mental health specialists, psychotherapy at co-payment rates equal to those for the treatment of physical disorders, and prescription medication for common mental disorders.
Read more about the President's New Freedom Commission on Mental Health and obtain copies of the reports here at the President's New Freedom Commission on Mental Health
Resources:
- Mental Health Issues Today, Volume 7 (2)
- NIMH Depression Publications, www.nimh.nih.gov or call toll free, 1-800-421-4211
- Report of a Surgeon General's Working Meeting on The Integration of Mental Health Services and Primary Health Car Held on November 30-December 1, 2000 At the Carter Center: Atlanta, Georgia
- The President's New Freedom Commission on Mental Health, Executive Summary, Final Report, July 2003
- Treating Depression To Help Cope with Other Illnesses: The Mind-Body Connection, Newsletter of the Depression and Bipolar Support Alliance, Spring 2003
- Collaborative Health Care Association, www.CFHA.net
