Closing the False Divide: Sustainable Approaches to Integrating Mental Health Services into Primary Care
Open Access
- 27 February 2017
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of General Internal Medicine
- Vol. 32 (4), 404-410
- https://doi.org/10.1007/s11606-016-3967-9
Abstract
Mental disorders account for 25% of all health-related disability worldwide. More patients receive treatment for mental disorders in the primary care sector than in the mental health specialty setting. However, brief visits, inadequate reimbursement, deficits in primary care provider (PCP) training, and competing demands often limit the capacity of the PCP to produce optimal outcomes in patients with common mental disorders. More than 80 randomized trials have shown the benefits of collaborative care (CC) models for improving outcomes of patients with depression and anxiety. Six key components of CC include a population-based approach, measurement-based care, treatment to target strategy, care management, supervision by a mental health professional (MHP), and brief psychological therapies. Multiple trials have also shown that CC for depression is equally or more cost-effective than many of the current treatments for medical disorders. Factors that may facilitate the implementation of CC include a more favorable alignment of medical and mental health services in accountable care organizations and patient-centered medical homes; greater use of telecare as well as automated outcome monitoring; identification of patients who might benefit most from CC; and systematic training of both PCPs and MHPs in integrated team-based care.Keywords
This publication has 61 references indexed in Scilit:
- Community-Partnered Cluster-Randomized Comparative Effectiveness Trial of Community Engagement and Planning or Resources for Services to Address Depression DisparitiesJournal of General Internal Medicine, 2013
- Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010The Lancet, 2013
- Collaborative Care to Improve the Management of Depressive Disorders: A Community Guide Systematic Review and Meta-AnalysisAmerican Journal of Preventive Medicine, 2012
- Collaborative Care for Patients with Depression and Chronic IllnessesNew England Journal of Medicine, 2010
- Promotoras as Mental Health Practitioners in Primary Care: A Multi-Method Study of an Intervention to Address Contextual Sources of DepressionJournal of Community Health, 2010
- Effect of Telecare Management on Pain and Depression in Patients With CancerJama-Journal Of The American Medical Association, 2010
- Brief psychological therapies for anxiety and depression in primary care: meta-analysis and meta-regressionBMC Medicine, 2010
- Optimized Antidepressant Therapy and Pain Self-management in Primary Care Patients With Depression and Musculoskeletal PainPublished by American Medical Association (AMA) ,2009
- Depression, anxiety and somatization in primary care: syndrome overlap and functional impairmentGeneral Hospital Psychiatry, 2008
- Twelve-month use of Mental Health Services in the United States - Results from the National Comorbidity Survey ReplicationArchives of General Psychiatry, 2005