Academic journal article Care Management Journals

Integrating Behavioral and Physical Health Services and Organizational Merger

Academic journal article Care Management Journals

Integrating Behavioral and Physical Health Services and Organizational Merger

Article excerpt

This article describes the process of the merger of two mental health agencies with a primary care physical health provider to establish within the merged structure an integrated behavioral and physical health delivery system. The purpose of this article is to share our experience with those administrators and staffof agencies planning an integration initiative of behavioral and physical health services.

Keywords: integration; behavioral health; primary care; health services; organizational merger

This article describes an integration initiative of behavioral health and primary care services within a larger agency that resulted from a merger of three organizations. It will be interesting to health care personnel that are planning a similar effort.


The organizational merger occurred in October, 2011 when Touchstone innovaré (TI), a mental health agency for adults with serious and persistent mental illness, and Proaction Behavioral Health Alliance (PBHA), an agency that provided medication and treatment for persons addicted to substances merged with Cherry Street Health Services, a federally qualified health center (FQHC) in a new building named Heart of the City Health Center.

The idea of integrating behavioral and primary health service delivery had been generally discussed by the executives of the three agencies involved in the integration initiative. A nationwide trend toward this combination has emerged in the last three decades promoted in part by the fact that persons with mental illness die about 25 years earlier because of the frequency of comorbid chronic physical conditions (U.S. Department of Health and Human Services, 1999). The approval of the integration initiative by network180, Kent County's public mental health agency, was secured following discussion and planning with the executives of the three agencies. The plan was eventually to extend the integration initiative to all the case management and treatment service departments of Cherry Street Health Services.


The literature about such integration is readily available through the Internet. These are some of them. Druss, Rohrbaugh, Levinson, and Rosenbach (2001) conducted a randomized trial of an integrated care initiative in a veterans affair (VA) mental health clinic and found that primary care visits and the use of preventive measures increased significantly among the experimental group. Wells, Morrisey, Lee, and Radford (2010) wrote about behavioral health services in community health centers similar to Cherry Street Health Services. Butler et al. (2008) described both the integration of mental health in primary care and primary care services in outpatient mental health settings and found that although both produced good outcomes, there were organizational and financial barriers involved relating to differing legal requirements that also affected reimbursement.

Blount (2003) discussed the efficacy of organizing information about the types of integration initiatives, the services offered, outcomes, and participant satisfaction to discover the best way to meet the needs of the clients. Collins, Hewson, Munger, and Wade (2010) presented a summary of the various models for integration designed to assist those interested in this effort in planning an effective program. Wulsin, Sollner, and Pincus (2006) also described integration options. A more specific outline was offered by Boardman (2006).

Another report by the Health Management Associates (2007) for the Robert Wood Johnson Foundation that sponsored it contains information about several other integration initiatives in public agencies in the country that might be consulted. The different approach to service delivery among these initiatives is caused primarily by the lack of comprehensive state plans and a defined working relationship among the governmental departments involved in regulations and funding. Many problems with integration initiatives result from the lack of implementing recommendations of the New Freedom Commission on Mental Health (2003) and the result from Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA) working together to establish policy, financing, and workforce guidelines for them. …

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