ares needed clinical information about the patient (consumer) to other clinicians also treating the patient (consumer)
- Collaboration is multidimensional, requiring: a shared understanding of goals and roles, effective communication, and shared decision-making.
- Care Coordination is the outcome of effective collaboration and corresponds to clinical integration.
- Clinical integration is the extent to which patient (consumer) care services are coordinated across people, functions, activities, and sites over time so as to maximize the value of services delivered to patients (consumers).
The interface of mental and general healthcare is well documented. There is a growing awareness of the influence of mental health and substance use conditions and the burden they place on individuals, overall health, and to society. Mental health and substance use conditions are widespread among persons with other health conditions including cancer, heart disease, diabetes, chronic obstructive pulmonary disorders, and other illnesses. Depression can adversely affect the management of chronic illnesses such as cardiovascular disease and diabetes2 . The Centers for Disease Control and Prevention (CDC) have pointed to the influence of mental health conditions on the onset, progression, and outcome of other illnesses3 . The CDC also points to the correlation between mental health conditions and health risk behaviors such as physical activity and tobacco use. There is also a growing body of research demonstrating the alarmingly high rates of overall health problems and premature death among individuals with serious mental illnesses4 . In fact, people with mental health conditions currently die 25 years earlier than other Americans5 .
Integration has proven to demonstrate improved health status in consumers and improved ability of physicians to manage mental health conditions6 . According to Mental Health, United States, 2004, a growing number of studies demonstrate that programs such as the chronic care model are effective and cost-efficient for improving the treatment of depression in primary care and that there are promising signs that the model is applicable to other mental health conditions. "Collaborative care has been shown to be predictably efficacious and effective if the type of relationship between mental health and medical providers, the population served and the type of service provided are adequately specified7 ."
The current health care system is unable to adequately address both sides of the primary care/behavioral health interface. Although primary care provides the majority of mental health care, barriers such as lack of financial compensation and available time with consumers make it difficult for health care systems to implement effective treatment strategies. Unfortunately, primary care providers commonly fail to recognize or treat some disorders including substance use disorders or depression. Physicians may lack the knowledge or the time to adequately diagnose and treat mental health conditions. Mental health providers suffer some of the same problems with a lack of knowledge of or time to diagnose physical health conditions.
The primary responsibility for providing mental health care continues to fall on primary care. In fact, 54% of individuals with a mental health condition are served in primary care settings. According to the American Academy of Family Physicians, 42% of patients with clinical depression and 47% with generalized anxiety disorder (GA) were first diagnosed by a primary care physician 8 . It is also important to note that most individuals prefer to receive their mental health care within primary care since it is perceived as less stigmatizing than the traditional mental health system 9 . The role of primary care identification and treatment of mental health conditions is important for special populations including older adults and low-income minority populations that are likely to go undiagnosed due to a lack of access to primary care. In addressing how to integrate mental health and general health, the 