In part two of our conversation with Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, Inc. (NYAPRS), Harvey offers insights that we hope will take you to new depths in thinking through the integration of primary health care and behavioral healthcare.
If you've read our previous articles, you know that we're all for integration, but want to make sure that it doesn't turn into a denigration of our services. Before we turn to Harvey for some strategic guidance, here's a quick review of why we're worried that integration could turn into denigration for those who depend on behavioral health services:
Bringing recovery values, principles, and practices into behavioral health services has been a staggering assignment. Resistance to acknowledging the reality of recovery has been very strong at times and, while there are places across the nation that now strongly embrace it, the concept of recovery from mental illness is still in its infancy. Many in our own ranks still do not agree that recovery is possible and do not have the slightest idea how to promote it. So, as we contemplate integration: Can we hold on to the recovery ground that we have gained? Is our grip on the concept of recovery strong enough to sustain its influence?
If behavioral health services are integrated into primary care, are primary care staff truly able (interested, trained, ready) to help those with behavioral health needs strive toward recovery? We know that, already, 75 percent of behavioral health services are delivered by primary care physicians. But what services are they delivering? Do they know that recovery is possible? Are primary care providers just prescribing medications or do they know how to promote recovery? Do they have the knowledge to help those with addictions or those who need housing, jobs, or community living skills? Probably not, we believe.
So with these two concerns to frame our conversation, let's hear what Harvey has to say.
No pressure Harvey, just tell us how to move through the process of integration and come out of it with improved services and more opportunities for people to recover.
Harvey: No pressure? OK, sure. Well, let me thank you both for this opportunity to share my ideas. I'll begin by sharing [National Council vice president] Chuck Ingoglia's view that, given the pending implementation of national parity and healthcare reform, “we are on the cusp of the most significant wave of public behavioral health change in the last 25 years.”
The fundamental overhaul and integration of our nation's health and behavioral health financing and programmatic models represent both major threats and opportunities for consumers, family members, and providers alike.
We think we know what he means because we feel both excited and threatened by the opportunities ahead.
Harvey: I agree and would like to focus on several of the opportunities. First, we have a tremendous opportunity and responsibility to ensure that the move [toward integration] helps us stop our community from dying 25 years earlier than the general public. Faced with a mix of major mental health, substance use, and complex medical conditions, many of us have been foiled by the fragmentation and poor coordination and outcomes of traditional care systems.
Getting away from the silos and integrating care is a welcome opportunity, so long as care is truly as person-centered and comprehensive as the rhetoric calls for. We need creative new models of integrated care that truly understand our community and incorporate all of the gains we have made in infusing recovery, self-help, and community integration into the medically based mental health model of the past.
We've learned that care needs to be offered with hope, sensitivity, and the promise of a meaningful life in the mainstream. We've learned that waiting passively for people to come to our more limited menu of services, then labeling them as “noncompliant” when they don't, is no longer acceptable.
So, we must make sure that integrated care doesn't simply turn the clock back to services run by medical personnel who see people as a collection of symptoms and illnesses. Wellness stems from promoting people's healing and respecting their dreams while addressing their complex challenges.
Before we get too upset about the shortcomings of primary care in serving people with mental illness and substance use issues, we need to remember that we in behavioral health haven't done a very good job of attending to the health needs of this group. As a system, we have gone kicking and screaming into to the notion of recovery, resisting it with all of our righteous wit.
If it weren't for a few researchers and the insistence of our consumers, we would still be assuring ourselves that recovery from mental illness is not possible. Maybe the concept of recovery would be a more natural fit with primary care than it has been with behavioral health. What do you think?