“I’ve been asked to build integrated-based services in my agency. Where do I even start?” Doris, the clinical director of the Hope Clinic asked the agency consultant, Rodis. “Congratulations.” He responded “You are being asked to do something challenging, noble, and required. You also are not alone feeling this way, and I am glad you are here. Let’s take some time, and think through the fundamentals so you get a framework to address the ins and outs of this much needed endeavor.”
Let’s start with operationalizing Integrated Care:
The word “integrated” means “various parts of aspects linked or coordinated.” The Latin word for it is “integer” which means “whole.” In this vein, simply looking at the Latin word integrated care would mean providing care that looks at the individual as a whole. There is a physical, intellectual, mental, and financial, aspect for each person, among others. And according the World Health Organization (WHO), the definition of health, as also found as one of the principles of its constitution, is phrased as, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” While this phrase was not constructed with integrated care in mind, it, along with the definition of the word “Integrated” can be seen as pivotal components to operationalize the concept of “integrated care.”
Now, let’s see what is currently or mostly commonly known about Integrated Care:
Currently, when talking about the term “integrated care” there are many different interpretations or beliefs about what it means.
Some are unaware of what that means;
Some see it as the integration of physical health and mental health;
Some believe it refers to “co-occurring disorders” and their treatment; and
Others regard integrated care as “holistic treatment,” in such case, advocating for better integration of spirituality in healthcare.
Each of these ways of viewing Integrated Care is incomplete, and so, the conversations, and information shared about Integrated-Care are lacking. As Rodis said to Doris, the best way to get this right from the start, which includes what we really mean by integrated care and its fundamentals, as proposed below:
Integrated Care means providing care to our patient and clients in the most in the most holistic and least fragmented way possible. It may be unwise, at times, to operationalize a concept, using its antonym. However, at other times, information is in the difference, knowing what we don’t want may be our first step to knowing what we do want, and in this vein, contrasting Integrated Care with fragmented care may be a concrete and practical way for us to define, or operationalize or understand what Integrated Care is.
In summary, and in other words, what is integrated care?:
Integrated care is the type of care that is provided to our patients and clients, in the most holistic way possible, and the least fragmented way possible, taking into consideration each individual’s needs regarding all the spheres of hers or his lives, including (and not limited to) the physical part, the mental health component, the behavior sphere, lifestyle, among others.
With this definition, you may then be asking: “How does one even start providing this level of care? The system is not designed for that!” The subsequent article will provide the answer to this question.
For more in this series of articles, check below!
Dr. Sidor is quadruple board certified in psychiatry, with vast clinical, teaching, supervision, mentorship, and management experience. He also has extensive experience in public speaking, leadership, business, and research, in addition to a passion for program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the past Medical Director and Chief Medical Officer for CASES (Center for Alternative Sentencing and employment Services), where he continues to see patients and consult on challenging cases. He speaks and writes fluently in six (6) languages—French, English, Spanish, Portuguese, Creole and Italian.
Dyer, R. Integrating primary and behavioral healthcare services. Criterion Health, Inc. Presented to National Council for Community Behavioral Healthcare conference, March 2002.
Trosahl, K, Robinson, P. How to plan and implement your primary care/behavioral health integration program. Presented to 3rd National Primary Care Behavioral Healthcare Summit. 1997.
Peek, CJ, Heinrich, RL. Clinical, operation and financial roadmaps for integrating medical and behavioral care. Presented to 3rd National Primary Care Behavioral Healthcare Summit. 1997.
Regier, N, Bishop,T. Blending community mental health with primary care: toward a sustainable model of integration. Prairie View Behavioral & Mental Healthcare. Presented to National Association of Rural Mental Health conference, August 2002.