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A hearth for our health

May 26, 2009
by Ronald W. Manderscheid, PhD
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Health promotion can be the ‘hearth’ within a medical home

Very exciting new developments regarding health are occurring at the margins of our field.

You may recall my January commentary on health reform was focused on the importance of positive health (“Making ‘health’ a noun”). Stated simply, this means that health promotion will (and should) be a major consideration in national health and healthcare reform. We all know intuitively that it is more effective and less costly to promote health than to treat disease. Now we need to seek practical and economical ways to do this.

At the same time, considerable national health reform work is under way on the medical home model. Several different types of medical homes are possible to achieve full integration of mental health, substance use, and primary care services:

  • Primary Core: The first model integrates mental health and substance use care into primary care settings. This model will be useful for the majority of Americans who experience short-term, relatively mild mental and substance use conditions.
  • Specialty Core: The second model focuses on the integration of primary care into mental health and substance use care settings. This model will be useful in caring for persons with serious mental or substance use disorders, for whom specialty care is of paramount importance.
  • Virtual Core: The third model relies on the use of care coordinators to coordinate a virtual integrated system based on each consumer’s specific needs. This model is particularly useful in care environments that remain fragmented and where systemic integration has not yet occurred.

Congress is developing options to incorporate the medical home into national health reform and healthcare reform legislation. It is very important that we express our opinion as a field on these options and actively advocate for improved quality care. Former Surgeon General Dr. David Satcher has been advocating care integration for more than a decade! We need to do so as well.

Almost two years ago, the Carter Center Mental Health Program undertook a very important initiative to remove policy and practice barriers that impede full integration of mental health and substance use care with primary care. This initiative is vital because it remains the only major effort in the field focused on addressing the essential policy issues around integration.

As part of this initiative, on July 7 and 8 the Carter Center Mental Health Program will host a Summit on the Medical/Health Home. The summit’s goal is bold: to incorporate health promotion into the medical home. One could think of this as creating a medical home with a hearth for health.

This summit could have very important implications for how our field operates. Health promotion is needed not only for persons free of any illness, but also for persons who do have mental, substance use, or primary care conditions. Health promotion can facilitate recovery. It addresses self-esteem, personal efficacy, well-being, a positive sense of the future, and hope. Each of these factors is very important to the journey of recovery chronicled so well by many consumers.

Health promotion also has the potential to delay the onset of other chronic diseases, such as diabetes, as well as to mitigate their effects once they have manifested. This is exceptionally important to save lives, because we know that public mental health consumers die 25 years prematurely as a result of these diseases and our failure to treat them effectively.

For more than a quarter century, literature has been accumulating regarding the pivotal role that health promotion can play in preventing and mitigating disease. Consumers have helped us understand this relationship through the notion of recovery, which bridges the dimensions of health and illness. In fact, experience-based evidence developed by consumers has provided a basis for practical work in health promotion within our own field.

Our hats are off to the Carter Center Mental Health Program for undertaking this groundbreaking work. Dr. Thomas Bornemann, the director, and Dr. John Bartlett, the senior project advisor, each are due considerable credit for conceptualizing and convening the summit. All of us will be in their debt for the landmark changes that we know can emerge from the summit. I wish them the very best in this endeavor.

Ronald W. Manderscheid, PhD, currently Director of Mental Health and Substance Use Programs at the consulting firm SRA International, Inc., worked for more than 30 years in the federal government on behavioral health research and policy. He is a member of Behavioral Healthcare's Editorial Board. To contact Dr. Manderscheid, e-mail ronald_manderscheid@sra.com.