“Integrated behavioral health” is looking like the phrase of the year in Olympia. Integration has many meanings in health care, but most fundamentally it refers to treating the whole person, whether wellness is threatened by physical illness, substance abuse, mental illness or behaviors.
As a community health center, Community Health Association of Spokane (CHAS) has been looking after all aspects of health for more than a decade – from toe to tooth and brain to behavior. But our state laws tend to remove the mind from the primary care body, regulating physical health and mental health separately, as if the two were not inextricably connected. And, too often, recent discussions about putting them back together through integration in the Medicaid system reference a framework designed for major crises and serious mental illness. I’ll leave the discussion of whether and how to change the county-led mental health system to others. But for my organization, and for any primary care provider, changes must include reconnecting the mind to the body in the primary care setting, where prevention is possible and costs are low.
The reason for change is clear: Those among us with mental health and substance use problems have a poorer quality of life and die younger while consuming more health care services. And of course, we have all heard too many tragic stories stemming from a mental illness that was identified only after the tragedy. Unfortunately, Washington is no more likely than any other state to catch and treat behavioral health illness early. We have an extensive, multifaceted and highly regulated system of care for the most severe mental illnesses and chemical dependencies. Although this system often struggles with shortages of inpatient beds, funding for outpatient treatment and linking to social supports, those who receive care get some of the best care in the country.
But the same regulations consider prevention, screening, early treatment and coordination of care as afterthoughts. What about the employee with heart disease who started drinking too much, still functions on the job, but probably won’t for long? Or the mother with diabetes whose depression has progressed from being down once in a while to struggling to rise from bed most days? Or the student with anxiety who used to do well in school but just can’t concentrate and sees his grades slip? These people don’t always seek the behavioral health care that could turn their situation around, but they do go to their local medical clinic while their struggles are manifesting.
The right thing to do for them and our state is to make sure that when they receive primary care, they aren’t just receiving medical care, but care for the whole person. When intensive behavioral health care is appropriate, all providers involved can do much more to coordinate care and enable smooth transitions. It is time to stop siloing the mind from the body and the various types and levels of care for the mentally ill.
Integrated care in the primary care setting greatly reduces hospital costs, reduces incarceration and homelessness rates, improves student achievement, and controls chronic disease. Many community health centers like CHAS are already on the forefront of behavioral health care, the critical first point where a patient and their provider agree that they need help beyond a physical illness. Our primary care teams include behavioral health professionals who work together with medical care teams, clinical pharmacists, health educators and care coordinators. We can do much more and go much further in allowing our professionals to practice to the full extent of their training in support of integrated and coordinated behavioral health care. But for this to become the standard of care, our legislators and regulators must recognize that integration starts with prevention and early detection at primary care clinics.