In this country we have had difficulty delivering basic health care to our citizens. We have had a larger problem delivering basic dental care to our citizens. We are almost unable to deliver mental health care given the constraints of the current system. Health insurance reform at this time will not provide the delivery system reform necessary to fix the oral health problem. It may provide resources that will help people get needed mental health care.

The Milbank Fund has published a report on mental health care delivery system transformation. In it they point out that the method of care delivery is important:

A comprehensive health care system must support mental health integration that treats the patient at the point of care where the patient is most comfortable and applies a patient-centered approach to treatment. Integration is also important for positively impacting disparities in health care in minority populations.

A 2008 report by Funk and Ivbijaro cited seven reasons for integrating mental health into primary care. Each must be considered in any effort to design or implement a collaborative approach, partial integration, or a fully integrated model.

  1. The burden of mental disorders is great. Mental disorders are prevalent in all societies and create a substantial personal burden for affected individuals and their families. They produce significant economic and social hardships that affect society as a whole.
  2. Mental and physical health problems are interwoven. Many people suffer from both physical and mental health problems. Integrated primary care helps to ensure that people are treated in a holistic manner, meeting the mental health needs of people with physical disorders, as well as the physical health needs of people with mental disorders.
  3. The treatment gap for mental disorders is enormous. In all countries, there is a significant gap between the prevalence of mental disorders and the number of people receiving treatment and care. Coordinating primary care and mental health helps close this divide.
  4. Primary care settings for mental health services enhance access. When mental health is integrated into primary care, people can access mental health services closer to their homes, thus keeping families together and allowing them to maintain daily activities. Integration also facilitates community outreach and mental health promotion, as well as long-term monitoring and management of affected individuals.
  5. Delivering mental health services in primary care settings reduces stigma and discrimination.
  6. The majority of people with mental disorders treated in collaborative primary care have good outcomes, particularly when linked to a network of services at a specialty care level and in the community.
  7. Treating common mental disorders in primary care settings is cost-effective.

The writers acknowledge barriers, including the traditional mind-body dualism which has led to silo thinking, the problems inherent in attempting information sharing with sensitive information,  and the fact that payment for mental health care is not assured even with the new law. helping is the fact that organizations such as the Carter Center are working to de-stigmatize mental illness

The report points out that vital to improving this care is the Patient Centered Medical Home, the team approach to care (incorporating mental health professionals and primary care practices), and stepped care. In addition, they propose the use of a (proven) model where patients with low health and high needs and low behavioral health needs are cared for in the primary care medical home, and those with high behavioral needs and low and high health needs are cared for in the primary care and specialty mental health setting, all in a coordinated fashion.

The report makes for an interesting read and offers concrete solutions to some vexing problems.

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