The Centers for Medicare & Medicaid Services (2010) states that the federal government in conjunction with the Affordable Care Act (ACA) are pushing for the integration of behavioral health care and primary care for individuals with serious mental illness (SMI).
All Over the Nation, Behavioral Health is Being Integrated into Primary Care
The Institute for Healthcare Improvement is partnering with approximately 30 organizations throughout the U.S. Together, they are integrating behavioral health services into primary care. Some states have already adopted this model of patient care.
A Program Created to Assist in Community-Based Behavioral Health Settings
In 2009, the Substance Abuse and Mental Health Services Administration (SAMHSA) implemented a Primary and Behavioral Health Care Integration (PBHCI) program. The PBHCI program was created to assist in funding community-based behavioral health settings. As of 2014, the SAMHSA has funded 99 settings. Each of these 99 settings fall within the gamut of integration and collaboration between behavioral health and primary care.
Patient Care Model Links Primary Care and Mental Health Services
At a Bellin Health Clinic in Ashwaubenon, Wis., a counselor sits among the doctors, nurses and other staff members. Several times each day counselor Dan Gesell meets with patients to discuss issues related to depression and anxiety, or any other matter that arises during a routine visit to the family doctor. It seems that pairing primary care with mental health services may very well be the future of the healthcare industry.
The Connection Between Mental and Physical Health
Gesell states that emotions, behavior, thought-patterns and physical health are all intertwined. For this reason, Gesell believes that an individual’s overall health requires more than just focusing on his or her physical ailments. He believes the cognitive and emotional sides of an individual must also be considered.
Individuals with SMI Have a Higher Mortality Rate
Individuals in the United States with a SMI, have a mortality rate that is two to three times higher than the rates seen in the general population. According to the Agency for Healthcare Research and Quality (2009), these individuals die, on average, 25 years earlier than individuals who do not have a SMI. A serious mental illness is defined as any behavioral, mental or emotional disorder that results in a functional impairment that limited or significantly interfered with at least one major life activity within the past 12 months (e.g. bipolar disorder, schizophrenia, etc.).
Behavior Related to the SMI May Contribute to This Increase
Persons who have a SMI die more frequently from diabetes and cardiovascular disease than individuals who do not. Behavioral risk factors may contribute to this increase in mortality and morbidity. These risk factors may include obesity, smoking, not adhering to medication schedules or disregarding medication altogether and limited physical activity. Poor access to care (including preventative) exacerbates the problem.
Closing the Gap
There is a gap between physicians offering patients the ability to seek assistance for issues related to their mental health and the patient actually seeking that assistance. With on-site mental health services, this gap may begin to shrink.
At Bellin Health Clinic, Every Patient is Screened
Each patient that visits the Bellin Heath Clinic is screened for depression and anxiety. This is true even for patients who are visiting the clinic for their annual physical. Much of Gesell’s schedule is open, which allows him to meet with patients on the same day they visit the clinic. When Gesell meets with a patient, he asks the patient what symptoms he or she is experiencing. Gesell performs an assessment and then, if necessary, looks into various treatment options.
Further Benefits of On-Site Mental Health Care Providers
Dr. James Jerzak is a family physician who assisted in creating Bellin’s patient care redesign. Jerzak states that prior to Bellin’s implementation of an on-site mental health care provider, patients in need of services were referred to an off-site mental health care provider. Once referred, many patients neglected to seek treatment.
By integrating a behavior health specialist into the core team of a clinic or medical practice, primary care physicians can eliminate the need for referrals and call upon their in-house consultant to provide patients with the behavioral health services they need.
As behavioral health specialists and primary care physicians work side-by-side, physicians will learn which patients they can handle themselves and which patients require treatment from their on-site behavior health specialist.
Colo. Wins a $65 Million Grant to Integrate SMI Services
Colo. received a $65 million grant from the Centers for Medicare and Medicaid Services to create a system that integrates behavioral and primary care services. Colo. is working to integrate community health centers with more than 400 primary care practices. The state’s goal is to provide almost every resident a way to access care by 2019.
Vatsala Pathy is directing this effort: She states that one barrier being faced has been the tradition of insurers just making the payments based on the services rendered instead of by the outcome of a patient's health. This approach encourages healthcare facilities to focus on which services are the most lucrative for the establishment, as opposed to the more holistic approaches.
Pathy expects that integrating mental health and primary care services will benefit patients in that this model will allow health problems to be addressed early on. In addition, she states that by addressing health issues before they become critical, the efficiencies gained through integration will save money.