Integrate physical and behavioral health care

Mental illness affects one in four people in the United States. There is a distinct possibility that you know someone who has battled with mental illness at some point in time. May is Mental Health Awareness Month and it is important to understand why it is essential to treat mental illness as seriously as physical illness.

Serious mental illness is more common than you think. One in 17 adults live with a serious mental illness such as schizophrenia, bipolar disorder or major depression. In addition, individuals living with a serious mental illness face an increased risk of having multiple chronic physical health conditions such as hypertension, asthma, diabetes, heart disease and stroke. Unfortunately, according to the Substance Abuse and Mental Health Services Administration, they also die on an average of 25 years earlier than other Americans, largely due to medical conditions that could have been treated.

The health care environment in our country is changing rapidly as we strive to provide care that results in better outcomes while controlling costs. One of the best ways to accomplish these objectives is the movement toward Integrated Health Care models. This approach requires a high degree of collaboration and communication among all types of health care professionals and addresses the needs of the whole person rather than any one particular diagnosis. Through community partnerships and affiliations, we can better systematically and cost effectively treat the whole person.

The integration of behavioral health and primary care is an example of such an approach. While mental illness impacts a significant percentage of our population, many health care systems have neglected mental health care for decades due to poor reimbursement, safety concerns, and the stigma associated with mental illness. In addition, payment systems and the infrastructure for treating mental illness versus medical conditions have existed in silos, thereby facilitating and reinforcing the stigmas associated with mental illness.

Failure to recognize and appropriately treat behavioral health conditions has a significant impact on overall health outcomes and costs. According to The Commonwealth Fund, individuals experiencing mental illness use more medical resources, are more likely to be hospitalized for medical conditions and are readmitted to the hospital more frequently. The American Psychiatric Association has found that health care spending for patients who have two chronic diseases simultaneously, in addition to mental health or substance abuse problems, is 2.5 to 3.5 times higher than for those without such problems, with the vast majority of the cost associated with general medical services, not behavioral health issues. Frequently individuals do not receive the health care services they need and deserve because their mental health and medical treatments are not being coordinated.

It is time for the integration of behavioral health and primary care to become reality in our country. Treating one's mental health or other medical conditions in isolation without consideration of the impacts of one on the other is simply not in the best interests of the individual, and is certainly not as cost effective as an integrated approach.

Locally, the Abbe Mental Health Center operates an Integrated Health Home (IHH) for adults with a serious mental illness that coordinates treatment for the mental and physical health needs of its 2,600 members in nine counties. We also address their social needs such as housing, transportation, education, family support and employment. Teams of nurse care managers, care coordinators and peers (individuals with lived mental health experience) coordinate needed physical and mental health services. Access to primary care services is critical and is provided through the Eastern Iowa Health Clinic or coordinated with the individual's primary care physician of choice. IHH subscribes to the whole-person treatment philosophy and works to assure that each member's behavioral and physical health care needs are met using an integrated approach that stresses preventive care and comprehensive planning and coordination.

Effective health care systems must include the ability to meet the mental health needs of individuals and address the barriers to accessing health care services. Integrated Health Homes are one of the innovative ways of coordinating primary and behavioral health care that can result in improved patient experience, better medical and behavioral health outcomes and cost efficiencies.

It is only when mental health is viewed as part of our total health that we will truly experience integrated health care delivery and the stigma of mental illness will be overcome. It is time that we all expect this to be the case.

' Dan Strellner is CEO of AbbeHealth, a non-profit regional mental health and aging services provider. Comments: dstrellner@abbehealth.org