Health-care reform is integrating physical
and behavioral health care.
BY REBECCA A. CLAY
Sixty-eight percent of adults with mental health conditions also have medical conditions, and 29 percent of adults with medical conditions have mental health conditions.
“If that’s not a reason to integrate mental and behavioral health
care into primary care, I don’t know what is,” said Rebecca B.
Chickey, MPH, director of the American Hospital Association’s
section for psychiatric and substance abuse services.
patient-centered medical homes in which multidisciplinary
teams of providers offer holistic, coordinated care to
individuals. Emphasizing prevention rather than focusing on
acute care problems such as urinary tract infections and ear
infections is key, said deGruy. “You can’t wait until diabetic
people can’t see or need their foot amputated,” he said. “You
have to get people into a program of care before they’re
physically or psychologically symptomatic.”
To improve chronic disease care, the first generation of
patient-centered medical homes used care managers, quality
improvement techniques and registries of patients with
particular diseases designed to identify gaps in care. But to
achieve the triple aim of better health care, improved health
and lower costs — what deGruy calls the “primary-care effect”
— patient-centered medical homes must also focus on the
whole person. “You can get a big leg up on comprehensiveness
by doing one thing: making sure your patient-centered medical
home has incorporated behavioral health care into the fabric of
its operation,” said deGruy.
Primary care isn’t the only setting where behavioral health
services are needed, deGruy added. Specialty care facilities such
as neurology labs and pain clinics can benefit from adapting the
lessons learned from behavioral and primary-care integration.
Reverse integration — bringing primary care into specialty
mental health settings — is important, too, deGruy said.
Integration can also happen system-wide, said Robin
Henderson, PsyD, executive director of the Central Oregon