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A career on the way to full service integration

December 22, 2014
by Ron Manderscheid
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I was exceptionally honored earlier this year to receive the Carl A. Taube Award for Lifetime Contributions to Mental Health. This award is made annually by the American Public Health Association (APHA) Mental Health Section at its national meeting. The award is especially meaningful to me because Carl Taube was my very good friend, colleague, and mentor at the National Institute of Mental Health (NIMH). This year marks the 25th anniversary of his untimely death at age 49.     

First, I would like to say a few words about Carl Taube.

As a young man, he developed and led the NIMH National Reporting Program for Mental Health Statistics, which I subsequently managed. Carl then went on to found the first NIMH national program in mental health economics, and he oversaw the rapid growth of a mental health services research field. He concluded his NIMH career as the Director of the Division of Biometry and Applied Sciences.

Carl was very intuitive, and he was very adept at negotiating bureaucratic hurtles. After retiring from the Institute, he went on to a second career at the Department of Mental Health in the Bloomberg School of Public Health at Johns Hopkins University. That second career was cut short by his death. The direction of my own career and research owe very much to Carl and his influence.

For my APHA award lecture, I chose to focus on the integration of behavioral health and primary care. Integration is a foundational issue confronting behavioral healthcare today, and it is one that we must undertake successfully as part of implementing the Affordable Care Act (ACA). This issue has been a primary focus of my own work for more than a quarter century.

As early as the mid 1980s, we came to recognize that the prevalence of chronic diseases, such as heart disease and diabetes, was disproportionately high in persons with serious mental illness. These diseases not only were more prevalent in this population, but they also occurred at an earlier age than in the general population. As a result, we even explored the potential of training primary care physicians to serve as case managers for adults with serious mental illness. However, during the late 1980s, circumstances were not welcoming for broad mental health service innovations, and these practices were not implemented in the service delivery world.

Early in the 1990s, we spent considerable time and effort thinking through the proposed Clinton Health Security Act. Like the much later ACA, the Clinton Act would have centered our health care system in primary care. Within the Clinton framework, mental health and substance use care would have become specialties affiliated with primary care, much as cardiac care is today. Subsequently, after almost two years of acrimonious debate, the Clinton Act was not passed by the Congress; however, many concepts generated by this work have continued to live on in other contexts.

In 1999, the then Surgeon General, Dr. David Satcher, published the first-ever Surgeon General’s "Report on Mental Health" in the 200 year history of the U.S. Public Health Service. This report was notable in two respects: First, it documented that treatment does work: mental health care does have a sound scientific base. Second, it called for the integration of mental health and primary care during the following decade.

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Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid

@DrRonM

www.nacbhdd.org

Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...