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October 29, 2012

How Can We Help Facilitate a True Integration of Behavioral Healthcare and Primary Care?

It is the expressed opinion by many that behavioral healthcare remains a fragmented and uneven system of care for individuals experiencing serious and persistent mental illness – both for adults and children-despite the best intentions of those of us in the field to make it more functional.

Funding has been insufficient to meet the range and severity of behavioral healthcare needs facing our communities. Doing "more with less" is a common mantra heard throughout the behavioral healthcare industry. Developing greater operational efficiencies, collecting measureable outcome information and sharing best practices remain works in progress.

The Affordable Care Act (ACA) promises to be an important step forward in serving as a catalyst for implementing new and more comprehensive ways for advancing our healthcare system. The integration of primary care and behavioral health care will be a key factor in helping to achieve a seamless "system of care" where benefits are improved and runaway healthcare costs can be reined in. The next generation of an integrated care model envisioned by many is one where we address the "whole person," including their bio-psycho-social functioning, their social support systems, spiritual awareness and connection to nature and the environment as a healing resource. The movement is toward "whole and person-centered care, peers as navigators, management of benefits and linkage of social services" (Manderscheid).

Essential to this successful integration, however, will require that behavioral health care be represented as an equal player/ partner in the decision-making process and that care is truly holistic. I believe such a process will require a significant conceptual change as, heretofore; behavioral care has often been positioned in a more adjunct role in the delivery of mainstream healthcare. Integration is needed, but compartmentalization of behavioral healthcare under the guise of a holistic care model will not achieve these goals. Our challenge will be how to stay on course and not settle for something less. Implementation of a truly integrated holistic model of healthcare will require a more egalitarian, horizontal model of care.

The question is how and can we in behavioral healthcare help move this more holistic concept to reality? Some ways I believe this may be possible are:

1.Behavioral healthcare interests must be "at the table" early and often in planning and policy making meetings, at national, state and local levels.

2.Taking an active assertive/advocacy role in these discussions will be essential, for all behavioral healthcare stakeholders. We have considerable knowledge, experience and expertise in delivery systems aimed at the whole person and can share this with a range of others in the healthcare field.

3.We can also listen to the perspectives of others across the industry. It will be important to incorporate ideas about what "person-centered care" will really mean in an evolving healthcare environment.

4.Collecting a range of input from recipients' and former recipients of behavioral healthcare services will be essential in order to develop a truly comprehensive construct of opinion. Collecting this input may require developing outreach initiatives and more creative means to insure these "voices" are heard.

5.Planning and linking people to critical and/or essential services in a "holistic" model of care means people are receiving the Right service at the Right time at the Right cost by the Right provider.

A fully integrated health care system offers the best opportunity to accomplish this, but only if behavioral healthcare is fully represented in this "comprehensive "array of care. I believe securing an active role and identity in a truly integrated healthcare system will be a challenging, but doable pursuit for the behavioral healthcare industry.

Too often our field has been relegated to ancillary roles in the overall healthcare delivery system, often underfunded, underutilized and sometimes misunderstood. In a system where persons with mental illness go untreated, undertreated or relegated to such inadequate community solutions such as jails/prisons, unemployment rolls, welfare assistance, or settling for substandard housing or less, we can and need to do much better. Those of us in the behavioral healthcare field can be advocates and inspirational guides to insist on achieving better for our communities by playing a lead role in helping to facilitate true healthcare reform that serves the "whole person"

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