Examining the Effectiveness of Integrated Behavioral and Primary Health Care Treatment

By Schmit, Michael K.; Watson, Joshua C. et al. | Journal of Counseling and Development : JCD, January 2018 | Go to article overview

Examining the Effectiveness of Integrated Behavioral and Primary Health Care Treatment


Schmit, Michael K., Watson, Joshua C., Fernandez, Mary A., Journal of Counseling and Development : JCD


Each year, approximately 61.5 million Americans, or one in five adults, experience some form of mental illness (National Institute of Mental Health [NIMH], n.d.-a, n.d.-b). Of these persons, 13.6 million are diagnosed as having a serious mental illness (SMI; NIMH, n.d.-b). The term SMI refers to a classification of disorders resulting in severe functional impairment for a period greater than 12 months (Insel, 2013; Kessler et al., 2003). Examples of SMIs include the diagnoses of major depression, bipolar disorder, and schizophrenia (National Alliance on Mental Illness, 2014). Among persons diagnosed with SMI, there is a disproportionately higher mortality rate from treatable physical health conditions such as cardiovascular disease and pulmonary disease, when compared to the general population with similar primary health care illnesses, as a result of not accessing the appropriate sector of care or receiving ineffective services in a specialized sector of care (Druss, Zhao, Von Esenwein, Morrato, & Marcus, 2011; Mardone, Snyder, & Paradise, 2014).

According to the Substance Abuse and Mental Health Services Administration (S AMHS A; 2012), only 40% of persons diagnosed with mental illness, including SMI, sought professional treatment from 2011 to 2012. Numerous reasons exist as to why persons with mental illness abstain from services, including the stigma associated with receiving health care services and perceived or actual barriers inhibiting them from seeking help (Clement et al., 2015; O'Connor, Martin, Weeks, & Ong, 2014). Consequently, barriers to the access and use of appropriate mental health services have had a devastating effect for persons with SMI, especially those experiencing confounding primary health care concerns (Manderscheid & Kathol, 2014; Mardone et al., 2014). As noted by Shim and Rust (2013), although the physical and psychological self are inextricably linked, policy makers and health care professionals historically have conceptualized mental health care and primary health care as distinctly separate, artificially creating separate entities of care. However, the confounding effects of depression, for instance, and chronic medical conditions, often make depression difficult to diagnose and medical concerns difficult to treat due to the paralleling effects on both the physical and psychological self (Melek, Halford, & Perlman, 2012).

The confusion experienced by persons in either the primary or the mental health care sector may contribute to an overall reduction in help-seeking behavior or prevent persons from accessing treatment entirely, and, more important, persons with SMI are dying from treatable health conditions (Barnett et al., 2012; Kessler et al., 2005; Mardone et al., 2014). As a consequence, persons with SMI who elect to refrain from professional treatment often rely on other methods to self-medicate, such as using alcohol or illicit substances, which is a common phenomenon observed in the SMI population (Brown, Bennett, Li, & Bellack, 2011). Thus, contemporary treatment for individuals with SMI should not only focus on the holistic self but also empower individuals by increasing their capacity for autonomy and ability to live a more independent and productive life (Stierlin et al., 2014).

An integrated behavioral and primary health care (IBPH) approach is one method of accommodating the needs of individuals with SMI that appears to have maximum benefit for society (Yoon, Bruckner, & Brown, 2013). Behavioral and primary health integration serves to address a phenomenon observed in the mental health population, in which the majority of individuals who receive mental health services also have at least one unaddressed chronic health condition (Texas Health and Human Services, 2015). According to Barnett et al. (2012) and Kessler et al. (2005), nearly 50% of individuals with a mental health disorder have at least one comorbid chronic medical disease (e. …

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