What is Integrated Care?

Integrated care occurs when primary care providers and behavioral health providers work together and systematically coordinate evidence-based and evidence-informed care for their patients with complex health needs.  Too often, individuals with mental illness and substance use disorders do not receive treatment for preventable chronic diseases, and these conditions may be exacerbated by poor health habits.  For example, a person suffering from addiction or in recovery may also have chronic back pain.  Prescribing opioids would not be in the patient’s best interests.  Another example is a senior who has diabetes and is anxious or depressed.

 

What is Integrated Care?

Both patients and healthcare professionals benefit from integrated care.  For patients, worse outcomes and higher costs result when both physical and behavioral health issues are not addressed together.  Research has indicated that mental illness often goes undetected and untreated in primary care settings.  Primary care physicians may not systematically question patients about alcohol or drug use.  Persons with serious mental illness die earlier from preventable chronic diseases like diabetes and cardiovascular disease.  Healthcare professionals and the health system benefit as early intervention reduces severity of disease and treatment costs.

 

What Are Barriers to Integrated Care?

Listed below are a number of barriers to integrated care.

  • Requires change in clinical culture
  • Continuing stigma and need for health professionals to view addiction as chronic disease
  • Care provided in silos
  • Need for supportive regulations, insurance reform, and coverage expansion
  • Need for adequate infrastructure (e.g., support for integrated data management system)
  • Access particularly in rural areas
  • Training of health care professionals about addiction and mental health
  • Lack of incentives for providers
  • Need for local and state leadership
  • Need for adequate infrastructure (e.g., support for integrated data management system)

This newsletter will focus on barriers related to the first two barriers-a need for a change in the clinical culture and for health professionals to view addiction as chronic disease. Integrated care calls for administrators of primary care and behavioral health care centers to champion a culture shift that values systematic coordination of co-located interdisciplinary patient-centered clinical services, requires cross-disciplinary training, and promotes data-driven outcomes.  Underpinning this culture shift is the interdisciplinary team’s understanding that addiction is a chronic disease, that stigma has no place in health care, and that early and periodic screening for mental and substance use disorders is critical to not only treat these disorders effectively but also to prevent the worsening of co-morbid diseases.

The remaining barriers will be addressed in parts II and III of future newsletters.