As the title suggests, I would like this first blog to be a consideration of the issue of integrating mental health and substance use services with primary healthcare. This has been a primary topic in recent years at conferences, workshops and in articles. In 2005, the Institute of Medicine issued a report after reviewing a range of documents and research, including the 1999Surgeon General’s Report on Mental Health and continuing with the 2003
President’s New Freedom Commission on Mental Health Report, and cited the importance of integrating mental health and substance use care with general healthcare. A common theme of all these documents is the importance of recognizing that “mental health is essential to overall health” and that if mental illnesses and/or substance use disorders are identified earlier, interventions can be more effective in alleviating the adverse impact of these debilitating conditions. Research has also indicated how depression and substance use can be a complicating factor in other physical diseases, exacerbating or causing those conditions. The case for integrating behavioral health evaluation and intervention into general health and primary healthcare settings was reinforced when the National Association for State Mental Health Directors (NASMHPD) released its data, in 2006, indicating that people with serious mental illnesses lived, on the average, a quarter of a century less when compared to the general population. Clearly, people will benefit by receiving better healthcare if they are treated in a holistic manner and obtain the right evaluation and treatment as early as possible.
However, what do we mean by integration of behavioral health services with general healthcare? There seems to be agreement that the integration of services needs to take place at the point of the individual receiving care. The person should be screened appropriately for mental illnesses and substance use disorders and a pathway to treatment needs to be clearly defined. People with serious mental illnesses should be consistently evaluated and treated for physical conditions that threaten their quality of life and life span. Some good news is that there are several models of effective service integration that are demonstrating positive outcomes. For example, Screening and Brief Intervention (SBI) has been showing good results in identifying substance use disorders and emerging dependence problems. A major challenge is how to bring these models of services integration and practices to the level of “common practice”. This challenge has been a primary focus of many of the forums mentioned earlier.
As we all consider how to realize the integration of behavioral health services with general healthcare, I think we need to be careful not to rush to integrated care without carefully considering what we want to gain and clearly identifying what we do not want to lose. The plusses of integration have been articulated by many experts and are partially considered in the above comments. However, consumers and families have gained influence in shaping policy and programs by voicing what they need to see in a service delivery system. The concept of recovery has had a profound impact on policy and program development and has been shaping outcome measures. We need to make sure we do not lose the ground that has been gained and the momentum to gain further ground in establishing a recovery orientation that is consumer and family-driven in service delivery and financing.