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June 19, 2013

Ten Ways We Can 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) and the recent development of 'health home" networks, as well as, Medicaid expansion promise to be important steps forward in serving as a catalyst for implementing new and more comprehensive ways of 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 healthcare delivery envisioned by many is one where we provide a truly "integrated" bio-psycho-social level of care that further recognizes functional aspects such as familial/social support systems, spiritual awareness, connection to nature and the environment as integral components of the healing process.

According to Ron Manderscheid, Executive Director of NACBHDD, the movement is toward whole and person-centered care, peers as navigators, management of benefits and linkage of social services. This successful integration will, inevitably, require that behavioral health care be represented as a key player/partner in the decision-making process and that care is comprehensive. 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 will not achieve these goals.

Our challenge in the behavioral healthcare field will be to stay on course and not settle for something less. Implementation of a truly integrated 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? Ten ways I believe we can help make this possible are:

1. Insure that behavioral healthcare interests are "at the table" early and often in planning and policy making meetings, at national, state and local levels. Taking an active assertive/advocacy role in these discussions will be essential, for all behavioral healthcare stakeholders.

2. 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.

3. Collect a range of input from recipients' and former recipients of behavioral healthcare services in order to develop a truly comprehensive construct of opinion. (Note: collecting this input may require developing outreach initiatives and more creative means to insure these perspectives are truly heard and valued.)

4. Co-locate behavioral health and primary care providers in order to build collaboration, improve overall care, achieve economic efficiencies and facilitate improved communications

5. Adopt a "recovery" outlook toward significant and costly physical illnesses, rather than a singular "maintenance/status quo" medical only approach. This links hope/motivation/outlook to the way that life/treatment is pursued and lived.

6. Leverage our behavioral knowledge and approaches to boost the acceptance and effectiveness of medical treatments by linking prescribed treatments to a behavioral willingness/motivation/readiness to change model.

7. Demonstrate the practical value of behavioral healthcare services to the community by actively addressing such key "wellness" issues as:

  • Homelessness
  • Drug abuse
  • Domestic violence
  • Behavior problems at work or in schools
  • Productivity in the workplace

8. Teach effective prevention skills to young audiences and bring more mental health services into our schools with a focus on keeping kids in school, learning everyday coping skills and supporting parents in keeping their children's education as a priority.

9. Establish more peer-operated services and give trained peers an expanded role in helping promote wellness programming

10. Reduce unnecessary hospital emergency room usage by implementing expanded crisis intervention training to law enforcement personnel and diverting appropriate psychiatric/intoxication cases to mental health crisis services and/ or sober living services.

Planning and linking people to critical and/or essential services in a comprehensive/integrated 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. The ten points above are but a few suggested ways to help achieve this end.

I believe assuming an active role and identity in helping to facilitate a truly integrated healthcare system will be a challenging, but achievable pursuit for the behavioral healthcare industry. In a system where too many people with mental illness go untreated, undertreated or are 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 in achieving better for our communities by playing a lead role in helping to facilitate true healthcare reform that is both comprehensive and fully integrated.

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