Integration of Primary and Behavioral Health

I have a graduate degree in Public Administration.  Because of this, people often try to get my opinion on current politics and legislation. To be honest, I am embarrassingly uneducated about these battles. I have an understanding of policy, the policy analysis behind both sides, and an understanding of the problem. But I have anxiety remember? The last thing I want to do is get involved in the political conflicts.

What my degree and interest focus on is what to do once the bill becomes law, the ‘how’ of government. Once a bill is passed by Congress and signed by the President, the hard work begins. How will the effected agency read over 2,000 pages of legal jargon, determine how it applies to their agency, and act in accordance with it?

As the election approaches, I think a mental health blog would be remiss in at least acknowledging the effect the Affordable Care Act (ACA) will have/already had on the field. While I have many many personal opinions related to this bill in general, as mentioned above—I aim to keep my blog out of politics as much as possible.  However, there are a few aspects of the bill that have a direct affect on the behavior health field that I’d like to address.

ACA aims to integrate primary health care services with behavioral health. Substance Abuse and Mental Health Services Administration (SAMSA), a key player in the metal health field, has listed integration as a top priority. They distributed 64 grants to programs around the country that aim for goals including but not limited to:

  • Improved access to primary care services;
  • Improved prevention, early identification and intervention to reduce the incidence of serious; physical illness, including chronic disease;
  • Increased availability of integrated, holistic care for physical and behavioral disorders; and
  • Better overall health status of clients.

Like many grants, the recipients differ greatly across the county. Some services that are funded by this grant include:

  • Facilitation of screening and referral for primary care prevention and treatment needs;
  • Providing and/or ensuring that primary care screening, assessment, treatment and referral be provided in a community-based behavioral health agency;
  • Developing and implementing a registry/tracking system to follow primary health care needs and outcomes;
  • Offering prevention and wellness support services;
  • Establishing referral and follow-up processes for physical health care requiring specialized services beyond the primary care setting.

These programs affect both inpatient mental health facilities and behavior health facilities. While I do not have personal experience with inpatient mental health facilities, while attending the Indiana Annual Recovery Month Symposium I heard several speakers on the topic. The integration aims to help inpatient facilities develop relationships with primary care physicians to treat the myriad of issues that often co-exist with mental illness. Bringing basic healthcare into inpatient facilities can speed the process of recovery by boosting the general health of the patient.

What I find more interesting is the implementation of screening techniques in primary care and introduction of behavioral health physicians into family and acute care facilities. Primary care physicians often have the most interaction with patients, giving them the greatest number of opportunities to detect concerning behavior. Research on the most effective screening techniques is now underway.

While listening to the nurse responsible for several integration programs in Indianapolis, I was jotting down all my brilliant ideas for educating primary care physicians better on the lesser known signs/symptoms/medications for mental illness. After all, if only my primary care physician had known to try the drug combination my physiatrist recommended I would have been better immediately! Fortunately, the nurse brought me back to reality by reminding us that integration aims to develop the connections and relationships BETWEEN the primary care physician and behavior health professionals; not force the primary care physicians to become specialists.

This integration is but one part of a new “hot topic” in the field of mental health: recovery centered care. The goal is to create increase the treatment of the “whole” person by building connections between the varieties of healthcare providers interacting with a patient.

I realize this post was a bit dry, but the goal is to set up the next few blogs related to this topic. It is currently a big ‘buzz’ in the mental health community world and I think we will continue to hear more about it in the upcoming years. Stay tuned for a blog showcasing the thoughts of a family care physician and her thoughts on the integration and role of primary care in behavior health.

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