Primary and Behavioral Healthcare Integration

On Monday the National Council announced that they have won a competitive grant to provide training and technical assistance to move forward the process of integrating primary and behavioral health care services. They will provide support services and assistance to organizations that have received grants to develop integrated care within their organizations, as well as to other organizations seeking to move in this direction.

 One of the pushes in the ARRA stimulus funding and in the health care reform law (Patient Protection and Affordable Care Act) was more efficient and cost effective provision of health services. One possible way to accomplish this for those who experience mental health and addiction problems is to integrate the care they receive for all illnesses, physical and behavioral. The National Council has been at the forefront of this movement. Their snagging of this grant demonstrates their commitment to the cause of integrating primary and behavioral health care for vulnerable populations. The press release indicates the following:

The Center will provide training and technical assistance to 56 organizations that have collectively been awarded more than $26.2 million in grants as well as to community health centers and other primary care and behavioral health organizations. According to HHS Secretary Kathleen Sebelius, these grants are part of an unprecedented push by the Patient Protection and Affordable Care Act to help prevent and reduce chronic disease and promote wellness by treating behavioral health needs on an equal footing with other health conditions.

When I have mentioned this topic in previous blog articles, the response has been disbelief that such integration will occur any time soon. After all, behavioral health private practitioners of our generation are not likely to dramatically change the way in which they practice, and now they mostly practice independently of medical settings.

In fact, it is even the case that many of our community-based behavioral health  organizations have a hard time seeing themselves moving toward providing primary care services for their consumers. At least one of our customers tried establishing a primary care facility as part of their organization a couple of years ago. The service did not take hold and they closed it. Perhaps they were too far ahead of the curve to be successful.

According to the National Council, the motivation to integrate general and behavioral health care among the chronically and seriously mentally ill is the significantly shorter lifespan experienced by those with serious mental illnesses.

According to a 2006 national survey, persons with schizophrenia, bipolar disorder and major depression have lower than average life expectancy and die, on average, at the age of 53 — often from untreated and preventable chronic illnesses like hypertension, diabetes, obesity and cardiovascular disease. Lack of access to primary care and specialty medicine is a critical factor in these tragic outcomes. . . .

The average life expectancy of the population at large in the U.S. in 2006 reached an all time high of 78.1 years. This 25 year difference is unconscionable. It is believed by many in the public health and behavioral health communities that integrating health care services for the seriously mentally ill and chemically dependent populations will encourage treatment regimens that will benefit both physical and mental health.

Most of the organizations active in this integration movement are considered ‘safety net’ providers. Although part of an endangered system,  ‘safety net providers are providers that deliver a significant level of health care to uninsured, Medicaid, and other vulnerable patients.’ They are the health care safety net that is intended to keep vulnerable populations from falling through the cracks in our costly and difficult to navigate health care system.

Are any of our readers among the 56 organizations that have received grant funding to develop integrated physical and behavioral health services? Do you see this as a possible and worthwhile goal for private practitioners to move toward? What changes in training models and practice models would need to occur to integrate primary and behavioral health care?

Let us know your thoughts about these issues. Please enter your comments below.

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