Academic journal article Journal of Mental Health Counseling

Integrated Primary Care: Why You Should Care and How to Get Started

Academic journal article Journal of Mental Health Counseling

Integrated Primary Care: Why You Should Care and How to Get Started

Article excerpt

Many mental health practitioners who are interested in primary care may not know how to get involved. Integrated Primary Care (IPC) is a model that normalizes mental and behavioral health issues in primary care with the goal of improved health outcomes; it shows promise for addressing mental health care disparities. Recognizing that mental and physical health problems are interwoven, utilizing the primary care system of medical health delivery offers an opportunity for patients to have greater access to behavioral services. Recent movements have increased the demand for integration of physical and behavioral health. This article reviews research on access issues, adherence, and the effectiveness of IPC with particular attention to newer studies and those examining culturally diverse groups. Finally, it offers suggestions for counselors seeking to integrate their practice with the primary care setting in a culturally sensitive way.

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In the U.S., mental health and substance use (MH/SU) services have traditionally been organized in mental health treatment centers and private practices. Although this system is well-developed and provides quality services, many individuals in need of MH/SU services are never recognized, do not seek, or are not adequately maintained in this model. This realization is the starting point for examining alternative treatment models.

THE CHALLENGES AND OPPORTUNITIES OF PRIMARY CARE

The primary care (PC) setting has been described as the de facto mental health care system. Of the 18-25% of people in the United States that meet the criteria for mental health disorders every year, only half seek treatment (Kessler et al., 2005). For those who do receive MH treatment, 70% of that care will be provided solely by the primary care physician (PCP; Regier et al., 1993). In primary care clinics serving low-income populations, mood and anxiety problems can approach 50% (Wang et al., 2005). PCPs typically under-identify MH/SU problems (Young, Klap, Sherbourne, & Wells, 2001), and when patients are identified and referred for specialty MH/SU services, 30-50% never make the first appointment (Fisher & Ransom, 1997). For low-income and ethnic minority patients, delivery of MH/ SU in the PC setting is even more challenging (see, e.g., Gonzalez et al., 2010).

Patients with psychosocial concerns typically present with physical complaints (e.g., chest pain, fatigue, dizziness, headache, insomnia) for which a biological etiology cannot be identified (Kroenke & Mangelsdortf, 1989). Moreover, the culture of some racial/ethnic minority groups (e.g., Native Hawaiians or Pacific Islanders) shapes emotional distress to present somatically (Sanchez, Chapa, Ybarra, & Martinez, 2012). Distressed patients consume more medical resources in the form of extra physician visits, frequent visits to the emergency department, and unnecessary tests and procedures (deGruy, 1996). Compared to those with chronic medical illness alone, patients with comorbid depression or anxiety report significantly more medical symptoms (Katon, Lin, & Kroenke, 2007) and cost more to treat (Petterson et al., 2008). Modifiable behavioral factors and unhealthy lifestyles are among the leading factors in the top 10 causes of mortality and morbidity in the U.S. (Mokdad, Marks, Stroup, & Gerberding, 2004).

More is needed than simply heightening use of the current MH/SU system because it cannot accommodate the volume of services needed, many patients will not seek specialty services, and the costs would be prohibitive (Strosahl, 2001). One tested solution is integration of behavioral health (BH) services into primary care, which is known as Integrated Primary Care (IPC).

Integrated Primary Care

IPC increases collaboration and coordination between PCPs and BH clinicians (BHCs). The degree of integration can vary from minimal to fully integrated (see Table 1). …

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