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Position Statement 13: Integration of Mental and General Health Care
Mental Health America is committed to the principle that mental health is an essential part of every person's health and well-being and that every child, adult, and family should receive mental health and substance use prevention, early identification, treatment, and long-term support regardless of how they enter the healthcare system.
Mental Health America believes that treating the whole person through the integration of mental and general health care will save lives, reduce negative health outcomes, facilitate quality care, and result in long-term cost savings.
Mental Health America believes that for people who live with chronic mental illnesses, general health is especially important, as a healthy body contributes to mental health recovery. Mental Health America believes that integrated healthcare systems enhance the essential role that social support services play in the recovery process.
Mental Health America believes that integration must involve the entire medical community and include the full continuum of mental health care services. Providers on both sides of the mental and general health care interface should receive full and timely information and should follow evidence-based protocols in order to identify and treat the whole person.
The Institute of Medicine (IOM) defines mental health integration (MHI) as a comprehensive approach to promoting the health of individuals, families and communities based on communication and coordination of evidence-based primary care and mental health services. It emphasizes integration as an example of quality health care delivery design that facilitates communication and coordination based on consumer and family preferences and sound economics.
The Institute of Medicine's report on Improving the Quality of Healthcare for Mental and Substance-Use Conditions1 characterizes integration or collaborative care as:
- Communication exists when each clinician caring for the patient (consumer) shares 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-eff