Clinical psychologist Kristin Canavera, PhD, MBE, explained at the inaugural Nexus Changing Care Together Summit, “We’re finally at a point in history where we’re recognizing that mental health is health.” This transformation is long overdue. Research dedicated to analyzing the gap in comprehensive, whole-person care has shown the connection between physical health and behavioral and mental wellbeing for years — but it seems like now the pieces are truly starting to come together to bridge the gap.
The fragmentation of medical and psychiatric services
Many individuals who experience both medical and psychiatric challenges have to choose between caring for their body or mind. Although the Centers for Disease Control and Prevention (CDC) website maintains that, “Mental and physical health are equally important components of overall health,” many are forced to prioritize one over the other.1 Indeed, there remains a mental and physical healthcare divide in the U.S.
It’s a harsh reality, and a cyclical problem, as untreated mental health needs can cause physical health problems like heart disease and diabetes. Likewise, chronic conditions can increase behavioral issues and mental illness. This is especially damaging for people with profound medical complexities and serious psychiatric needs.
Bridging the gap in behavioral, mental, and primary care improves patient satisfaction, reduces negative outcomes, creates more efficiencies, and saves costs
Mental Health America (MHA) believes whole-person care not only improves outcomes but also promotes efficiency and cost savings:
“Behavioral health has historically been authorized, structured, researched, financed, and regulated differently than general healthcare, and mental health and substance use disorders have been treated both separately from each other and separately from primary care. This historical separation is now generally understood to have been counter-productive to achieving person-centered, comprehensive health goals.”2
Integrated care is the solution. Patients and their caregivers need access to a team, including behavioral health clinicians and mental health professionals in addition to medical providers. While this interdisciplinary approach leads to increased coordination between disciplines, it also increases each individual provider’s ability to identify and begin addressing a patient’s physical, behavioral, and mental health needs.
This comprehensive take on healthcare not only ensures patients receive the total care they require for better outcomes, but it also ensures local healthcare facilities are equipped to provide concurrent medical and psychiatric care. Anecdotally, health systems that are already providing an integrated care approach have reported admitting patients who have been turned away from dozens of acute medical hospitals and/or psychiatric facilities. This highlights the issue: when co-occurring medical and behavioral or mental health needs are present, most facilities are not designed to or have staffing or policies in place to treat the individual.
Caring for medically complex pediatric patients
Lack of integrated care is detrimental to anyone’s health, but especially harmful when it comes to the care of children, adolescents, and young adults. As Dr. Canavera and Liza-Marie Johnson, MD, explain in their Pediatrics Perspectives article, this type of fragmented care forces patients to be admitted to facilities hundreds of miles away from home (if not states away), limiting vital caregiver participation in their treatment.
In “Integrating Mental Health Care for Medically Complex Children,” they describe a patient with complex needs who struggled to find inpatient psychiatric treatment within a medical facility. “[The patient’s] providers were faced with the challenge of balancing what was in her best interest, treatment of her pneumonia, cutting behaviors, and suicidal ideation, with the reality that in their community no facility could provide a standard of care for both medical and mental health concurrently.”3
The current system is failing America’s youth with serious mental health and medical needs. The CDC reports the second leading cause of death for children and adolescents 10-14 years old is intentional self-harm,4 and it’s been previously explained in this article the link between those with chronic illness and increased risk of behavioral and/or mental health challenges. These figures shed light on the absolute necessity of integrated medical and psychiatric care — so why is more not being done across American healthcare overall when this is a well-known and documented issue?
Barriers to integrated care
The connection between the body and mind is clear, so why has American healthcare not changed to a more collaborative approach to treat the whole person? Barriers range from the high caseload to data sharing and electronic records, to lack of availability and time to diagnose and treat.4 Until these obstacles are addressed globally, patients with co-occurring medical and behavioral health needs will continue to receive fragmented care.
Although, change to American healthcare is possible. Some efforts are in place to integrate care, as described by the Commonwealth Fund, a private U.S. foundation that aims to improve healthcare access, quality, and efficiency. Regardless of how you phrase it — holistic, comprehensive, integrated, collaborative — the Commonwealth Fund details common elements that exist across models,5 including:
- Team-based care, where multiple types of providers collaborate to address a range of patient care needs.
- Shared information systems, such as electronic health records, to improve coordination across providers while maintaining patient privacy.
- Measurement of patient outcomes using patient registries or tracking tools.
- Individualized, person-centered care that incorporates family members and caregivers into the treatment plan.
Although these features are great, and will undoubtedly drive better patient outcomes, they still fall short. A true integrated medical and psychiatric approach should be provided in one setting, taking the onerous off the patient and caregivers and placing more trust and responsibility on the healthcare facility.
True integrated healthcare is available today
If you, a loved one, or a patient has unaddressed physical, behavioral, or mental health needs, consider reaching out to Nexus Health Systems. With hospital and residential treatment center (RTC) settings, the Nexus network provides interdisciplinary treatment to ensure the whole person is taken into view and cared for, ultimately setting them up for better, lasting outcomes.
Sources
1Centers for Disease Control and Prevention (CDC): “About Mental Health”
2Mental Health America: Position Statement 13: Integration of Mental and General Health Care
3 Pediatrics Perspectives: Integrating Mental Health Care for Medically Complex Children
4Centers for Disease Control and Prevention (CDC): National Center for Health Statistics
