The Benefits of Integrating Behavioral Health into Primary Care

Mar. 06, 2015
Clinton Foundation Health Matters SummitFrom the 2015 Clinton Foundation's Health Matters Summit.

Adults in the U.S. living with serious mental health conditions die on average 25 years earlier than others, largely due to treatable medical conditions. It’s clear that mental and physical health are intertwined, and care for both should be linked together within health care delivery systems.

Fortunately, health experts are starting to recognize this, and implement strategies to combine mental and physical healthcare.

At the end of January, the Clinton Foundation held its annual Health Matters Summit in Indian Wells, Calif. The summit is an annual event that showcases what the Clinton Foundation's Health Matters Initiative and its strategic partners are doing to create systemic health improvement throughout the U.S.

This year included a panel hosted by Dr. Gail Saltz, M.D., and included insights from Mohini Venkatesh of the National Council for Behavioral Health, John MacPhee of the Jed Foundation and William Emmet of the Kennedy Forum. The focus was on integrating mental health services into primary care: in effect, turning local healthcare offices into a one-stop shopping experience:

“When you talk about mental health, we really are talking about people with cardiovascular disease, diabetes, COPD, with asthma,” said Saltz at the event. “Because chronic illnesses absolutely cause mental health issues, and mental health issues make those chronic illnesses worse, we have to start talking about that in an integrated sort of way.”

In addition, integrating therapists into a primary health care setting could ease the concerns of people worried about the stigma of receiving psychological care. Emmett also proposed the usage of a Tel-Med-type program that would allow physicians to bring a mental health provider into a conversation with a person who is there in the doctor’s office.

Another practice model discussed included training college community leaders on how to screen for the signs of depression, thus integrating services on campuses. According to MacPhee, 80% of students who died from suicide never even visited the counseling center on campus, but had been to the health center.

Following the panel discussion, the audience discussed ideas for improving mental health care. Linda Evans, associate administrator of Business Development at JFK Memorial Hospital in Indio, Calif., spoke about a model in Texas where psychologists and physicians were teamed up to provide immediate intervention for patients showing signs of depression or other behavioral health issues. However, the common problem was sustainable funding.

Locally, Evans suggested a possible collaboration between the medical community and some of the valley’s many nonprofit agencies that work with stroke, Alzheimer’s, cancer and other individuals and their caregivers.

Ultimately, the common thread behind each of these proposals is communication, and not just between doctor and patient, or between healthcare providers. The more open the public is to discussing mental illness, the harder it is to stigmatize those living with it. Towards the end of the panel, MacPhee made the following plea to the audience to “own” mental illness:

“[If] every individual can own it, where we all talk about it and we can all admit it, we can really accelerate the removal of the stigma and prejudice around it," said MacPhee. “This is an issue that affects all of us.”

Comments
Lynn
This integration of care is critical to physical and mental health. In theory, it is one of the best proposals of holism with patient care. That said, aside of funding, we need to address the stigma of mental illness within primary care physicians.specialists,registered nurses and other direct care patient providers. How to do this is complex. Perhaps it should start with implementing teaching in school at the elementary level. Science class perhaps,mandantory health classes, etc. Mental health needs to be integrated into course study and continued throughout ones education. Medical schools need to spend more time educating their students in a non biased way in mental health. Integration will encourage "out of the box",critical thinking for physicians, making better doctors in general. Mental health illness can cause many physical illnesses,and physical illness can cause mental illnesses. Physical illness exacerbates mental illness and mental illness exacerbates physical illness. If we see the potential in the ability to provide the best possible care to patients by care integration perhaps we can make further progress in stigma reduction.
12/1/2016 1:08:52 PM

melanie campbell
I have Bipolar and my doctor wants to change my med to Latuda, but I can not afford it. I have medicare - humania - and having that I can not find help to pay for it. The med is very expensive and I need to find some assistance. I live in Louisiana. Does anyone know of a program that you are on or know of one that would apply to me. T/Y so much for your help. Melanie
4/11/2015 11:09:07 PM

Deborah Tyler
I have Narcolepsy with Cataplexy, TRD, and Panic Disorder. Am on SSA & SSI which is a whopping $740mo. My PCP refuses to prescribe any drugs used for mental heath or the medications for Narcolepsy. My mental health conditions have gone untreated because the services available are few and just to limited to make it worth all the crap to get it. I go days or weeks without seeing anyone, have no friends left and rarely even get out of bed anymore. Cant get a job and what I get isn't nearly enough to live on let alone buy gas or do things with friends. No wonder there are so many homeless, and they drink. What's left anymore for them?
4/8/2015 6:53:20 AM

Sandy B
My son struggles for mental illness; he has migraines and the psychiatrist won't help; but going to multiple doctors is difficult for him. Integration would be best case scenario.
3/28/2015 11:22:37 PM

Bob Vanden Boom
My mental illness begin in May of 2001. I was in a terrible motorcycle crash when a person pulled there out in front of me. Finding out after being in a medical induced coma. I found out I had no memory what so ever. All my training.Schooling. Importance of the postion I held at the workplace for 25 years. To this day. My short term memory hasn't got any better. I see doctors for mental health on a regular basis. My anger levels went through the roof. My threats of getting divorced from a 28 years marriage was aweful. Very hard for me to handle, Disgraced and ashamed. Having low self esteem. I didn't have the punch in me to fight back for what I felt was right and what was mine. I took over the property than we were going to use when we both took vacations. Living alone. As I am to this day. Is the most worse anyone would ever want to go through. I forgot how to cook. In which I was mighty good at. Forgot how to read. Had to reteach myself. Couldn't drive due to the loss of my driving privileges for fear that I might have a seizure. And put others in jeapordy. 2 years before I got the returned. In 2007 I contracted prostate cancer. Another wall to climb over. Finding out the depression I was in. Got so low. I was becoming a heavy drinker. Then suicide came into the picture. I was still well enough to put a stop to it. Told my family and sold my place and moved back (home). To be closer and surrounded with family. (brothers and sisters). I take handsful of medicine. Too many to pinpoint each one. I spend countless of dollars on them. Problems with thirst and much more. Unable to use my left side like I once did. That along with memory loss. Has been so tough to live with. My anger has come down. But not gone. Mental health is in my insurance only with a higher co-pay. I slowed that up due to the cost of the co-pays. Even when I did see the doctor for mental health. I am to shy to tell her about my problems. It's embarassing to me. I find it so difficult to open up. I hold the anger in. Knowing that if I let it go. I will only be placed on more and different medicine. I have a fear of talking to people. I feel I don't have any friends anymore. Figuring my X wife told everyone that I was a bad a terrible person. I see them differently. And I'm sure they do to. I can't stand living with disabilty. For I fear I can't do my share. My life is a bummer. And I hate it.
3/28/2015 10:42:12 AM

Michael Walker
My primary care physician (PCP) had been my lifeline in my area, I had no mental health team since relocating to South Carolina. He had been the one there to support me through three major depressive breakdowns and through a critically needed SRI change. I had been treated unfairly at work and then fired because of my depression and panic attacks. My PCP got me on a new SRI and tried to get me a psychiatrist. None would take me and then finally, nine months later one takes me in, and was completely unwilling to continue the current SRI... This psychiatrist wanted me back on Prozac (a bad choice for me historically), when I wouldn't agree they let me go. My employer sent me home without pay for three months, yet the new SRI was effective, I pulled out of my downward spiral. Without my PCPs support I may not have made it through that crisis.

1.5 years later... My new HR director requires me to get a Dr.'s note describing my mental health issues. I wait after my appointment to meet with the office manager. They believe I was in crisis and my PCP involuntarily hospitalized me and then dropped me from their practice, and never provided the note or even talked to me again. The CEO of the practice claims that I withheld the nature of my "severe psychosis" from them.

That is a double lie. I have major depressive disorder, panic and anxiety disorder, and maybe ADD or Bipolar. Almost every visit to my PCP detailed my anxiety and my depression. The CEO, also my former sleep specialist, lists his adamant opinion that I do not struggle with ADD, in each of our appointment notes. This practice dumped me and left me out in the cold.

Fortunately things are looking fine. A new psychiatrist is finally scheduled. My new PCP will not prescribe my SRI nor do they want to talk about my mental health. I've got better care now but the costs were phenomenal. We will need to slowly pay off $4000 or more! New PCP visits. New sleep specialist. Huge scare for my wife.

We need a single payer system overall.

We need our doctors to keep the Hippocratic oath and to care for us, mind and body.

Which perpetuates or exasperates my mental foggy-ness, forgetfulness, and chronic exhaustion that leads to my termination?

Major depressive disorder? (SRI is currently effective) Panic and anxiety disorder? (Panic stopped me from speaking clearly in HR, I believe this is why I was terminated.) Migraine head aches? (These are believed to be caused by Seratonin and treating them risks serious consequences, but my neurologist cannot talk to me about my treatments for depression.) Sleep Apnea? (CPAP helps my wife more than me) ADD/ADHD-inattentive type? (No Psyciatrist has been willing to diagnose it because of my depression history and anxiety, yet all agree that I am suffering from problems due to my inability to attend as others do.)

In South Carolina and in other "Right to Work" states contract law and the ADA are very hard or even impossible to enforce in cases related to termination of employment. How do you even get 504 accommodations for panic attacks and depression, and the awful symptoms that follow serious breaks? Add a history of limited worker's rights and a culture against unions. Add Doctors dropping clients from their practices, often because of their mental illness. Where are we going next?

Hopefully those that care for us all will keep fighting for us all. Hopefully we can all help end the stigma.

Ending this false separation between mental and physical health would be a welcome start.
3/25/2015 9:43:33 PM

Michael L Green
This is why I have problems explaining myself.
3/25/2015 8:02:05 PM

Michael L Green
It sounds great but trying to get support from my primary doctor who is covered by my Medicare insurance with my physiology doctor who does not take Medicare insurance leaves me no chance of help and continues to keep me in severe depression and nowhere to go to get help with getting off medication that is causing my problems physical and mentally to get HELP!
3/25/2015 7:58:09 PM

Kapreka
I agree with the article. If we integrate behavioral and physical health services then maybe more people will feel less ashame and receive mental health services.
3/16/2015 9:37:21 PM

Star Gomez
This would be a dream come true!!
3/14/2015 11:04:35 PM

elvia
I agree that care needs to be integrated- but I think the patient/customer needs to be empowered to make their own choices-- educated, informed, thorough decisions...
3/12/2015 5:44:28 PM

Carmen dorta
A wonderful thing to do for people with mental health issues that have chronic illnesses especially pain may god continue helping u find ways to help people.god bless u.
3/11/2015 6:50:43 PM

Linda DeMent
This integration is long overdue! My 27 year old son died last year as the result of an accidental heroin overdose. His addiction was a direct result of undiagnosed mental health issues. He had no health insurance but, even if he did, any mental health visits and treatment would likely have been quite limited.

That said, I have had very supportive integrated help from my oncologist at Seattle Cancer Care Alliance. Upon learning of my son's death, she immediately wrote a referral for mental health support. I was quickly able to begin counselling at SCCA and it has been very helpful.

I recognize the multiple consequences possible to individuals, their families and communities that result as a lack of diagnosis and treatment. It is to everyone's benefit to integrate mental and physical health care.
3/11/2015 5:34:28 AM

ruth
I suffer with pnd and have always had depression, i have found people do not understand it at all. I have two young childern and i am on my own.. I feel the biggest problem in this service is the lack of childcare provision for mums.. Lewisham in london has so many amazing services but the one thing its missing is more help for people in my postion. Mums have the right to get better and childcare would be such a big help so getting to couseling sessions was possible and also going to groups for support was easer.... My childern are my life line and i love them to bits they make me smile everyday so to be able to get better for them is what keeps me going on a daily basis!
3/11/2015 3:39:26 AM

Judith Craddock
This has been such a huge issue for me. I have been on the Chronic Illness Journey for most of my life. In turn, I deal with mental health issues because the journey invades the quality of my life. At 70, I am very much ready to stand up and be counted as one whose physical health has a direct correlation to my being able to maintain a semblance of mental "normalcy." Also, I have had many physicians who seem hell bent in furthering the stigmatization of mental suffering. I have been dealt the hand of having many "questionable" illnesses: Multiple Chemical Sensitivity, Hyper Electrical Sensitivity, and what has always been considered a "Waste Basket Diagnosis" : Chronic Fatigue Syndrome. (Recently recognized as Systemic Exertion Intolerance DISEASE. ) One physician actually said to me""You're a little crazy, but we love you anyway." This while patting my knee! It took me a while to recover emotionally from this. It served, however, as a catalyst to my own refusal to hide my struggle in shame. The hardest part for me, now, is living in a small town with very limited mental health support. AND... the co-pay for counseling.. if I were to find one compatible with my issues.. is $40.00. This, in itself, lends itself to the struggle.. and a feeling that my need for help is not supported. My co-pay for a doctor visit is $20.00. The $40 co-pay is a real financial struggle, and adds to my guilt for needing this kind of service. I am very vocal about all of this now. Hoping that those who follow me will find the journey a bit easier.
3/11/2015 12:36:10 AM

Jacquilyn Otis
Loved this message. So hard to help if there is no acknowledgement and so hard to get past the stigma to acknowledge. Starting to see it in our local practices.
3/10/2015 5:49:17 PM

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