Integrated Care: The How


Integrated Care: The How

“This way of defining and operationalizing Integrated Care has been very helpful to me. It also has given me food for thought and I have found myself wondering, “How do we really get this done?” Doris, the Clinic Director for the HOPE clinic articulated these words to Rodis, the agency consultant, during her second meeting with him regarding a project she has been tasked to lead on integrated care services. “Naming and defining are the first two steps to knowing. Now, let’s get to the third step, which is that of categorizing, and from there, we will be able to have some clarity on the how of integrated care.,” explained Rodis to Doris.


In a previous article, entitled “Integrated Care: Operationalizing it.” I explained the different responses regarding different ways in which Integrated Care is understood. Integrated care was then subsequently operationalized as the type of care provided to an individual in the most holistic and the least fragmented way possible, taking into account all aspects of each individual. The question now is “How do we provide such care?” And this is the object of this article:


Integrating physical and mental health:

Integrated Care: The How

This has been the most studied, the most researched, the most common form of integration, and the most sought after. Integrating physical and mental health has gained much ground from the recognition that almost all conditions are now psychosomatic, with a non-linear etiology. Furthermore, successfully treating what we used to call a “physical condition” is influenced by what we used to call a “mental condition” and vice versa. As we realize that our patients and clients with untreated depression fail to take their medications for diabetes, or HIV, or Lupus, it has become increasingly obvious for us to integrate physical health and mental health services. Nonetheless, for proper physical and mental health integration, some preparation is necessary:


1. The need contribution from everyone:

Integrated Care: The How

Everyone, at all levels, from administrative leadership, medical leadership, social services leadership, to direct service worker, needs to be a buy in to the spirit of implementing a new way of practicing and of integration of services. Part of the agency contribution and buy in entails the financing of integration, with the understanding that some shifting may be required to go from a short-term to a long-term attitude around investment and return on investment.


2. The need of a multidisciplinary team:

Integrated Care: The How

The challenges of providing care in a silo are well known to all. The complexity of our patients and clients, the complexity of their needs, the level of care they require, and the complexity of the system, all makes it challenging to provide care in a silo. Integrating physical and mental health care not only adds to this complexity, but also is a requirement for proper integration. There are several models available for the integration of physical and mental health services, and this goes beyond the scope of this article. What is certain, however, is that starting to think about the need for a multidisciplinary team, its composition, how to best leverage the dynamics, is a requirement for successful implementation of integrating physical and mental health services.


After naming and operationalizing the concept of Integrated Care, it is necessary understand the how of implementing it. One practical way to do so is to look at the different categories of Integrated Care, starting with the integration of physical health and mental health and looking at two of the required components for adequate implementation. The subsequent article will be about additional components required for a successful implementation of integration of physical and mental health; in addition to other ways of making integrated care a successful endeavor.


For more in this series of articles, check below!


References:

  1. Human Services Research Institute and the National Association of State Directors of Developmental Disabilities Services. 2014. “NCI Indicators.” Accessed March 15. www.nationalcoreindicators.org/indicators

  2. Dea, RA. The integration of primary care and behavioral healthcare in Northern California Kaiser-Permanente. Psychiatric Quarterly 71(1):17-29, 2000.

  3. Report. Surgeon General’s working meeting on the integration of mental health and primary health care. US Department of Health and Human Services, Public Health Service, Office of the Surgeon General. 2001.

  4. American Association of Community Psychiatrists. Position paper on interface and integration with primary care providers. October 2002.

  5. Doherty, WJ, McDaniel SH, Baird, MA. Five levels of primary care/behavioral healthcare collaboration. Behavioral Healthcare Tomorrow. October, 1996:25-28.