Mental Health, Primary Care Collaboration Urged

Article excerpt

NASHVILLE, TENN. -- Integrating mental health and primary care has the potential to reduce medication mistakes and improve communication among providers, experts said at the annual conference of the National Academy for State Health Policy.

"This is a medical error reduction opportunity as well as a quality and cost opportunity," said Joseph J. Parks Jr., M.D., a psychiatrist and medical director for the Missouri Department of Mental Health.

The status quo isn't working, he said. Individuals with mental illness have increased or early mortality, have high rates of medical comorbidity, and receive inadequate and poorly coordinated health care.

Mental illness also predicts underutilization of medical services. A study of older patients with psychiatric disorders found that individuals with diabetes were less likely to receive more than one medical visit if they also had schizophrenia, bipolar disorder, or posttraumatic stress disorder. Patients with hypertension and any psychiatric disorder were also less likely to have more than one medical visit (Psychiatr. Serv. 2002;53:874-8).

There are several models for integrated mental health and physical care, including embedding primary care in a mental health program, creating a unified primary care/mental health program with common administration and financing, and improving collaboration between mental health and medical providers.

Evidence seems to show that trying to create linkage is difficult, Dr. Parks said. "Collaboration is basically an unnatural act between separate organizations," he said. While this model is easier to set up initially, it is harder to make successful over the long run.

Models where primary care is embedded in mental health clinics or primary care and mental health programs are unified are harder to set up initially but easier to operate day to day, he said.

In general, the colocation of services is popular with both patients and providers. On the provider side, it allows physicians and other providers to have a more accurate understanding of one another's incentives, methods, and constraints, Dr. …