Skip to main content
Erschienen in: Journal of Clinical Psychology in Medical Settings 1/2009

01.03.2009

The Challenge of Integrated Care for Mental Health: Leaving the 50 minute hour and Other Sacred Things

verfasst von: Andrew S. Pomerantz, John A. Corson, Mark J. Detzer

Erschienen in: Journal of Clinical Psychology in Medical Settings | Ausgabe 1/2009

Einloggen, um Zugang zu erhalten

Abstract

A growing body of research has demonstrated the effectiveness of integrating mental/behavioral healthcare with primary care in improving health outcomes. Despite this rich literature, such demonstration programs have proven difficult to maintain once research funding ends. Much of the discussion regarding maintenance of integrated care has been focused on lack of reimbursement. However, provider factors may be just as important, because integrated care systems require providers to adopt a very different role and operate very differently from traditional mental health practice. There is also great variability in definition and operationalization of integrated care. Provider concerns tend to focus on several factors, including a perceived loss of autonomy, discomfort with the hierarchical nature of medical care and primary care settings, and enduring beliefs about what constitutes “good” treatment. Providers may view integrated care models as delivering substandard care and passively or actively resist them. Dissemination of available data regarding effectiveness of these models is essential (e.g. timeliness of treatment, client satisfaction). Increasing exposure and training in these models, while maintaining the necessary training in traditional mental health care is a challenge for training at all levels, yet the challenge clearly opens new opportunities for psychology and psychiatry.
Literatur
Zurück zum Zitat American Academy of Family Physicians. (2008). Joint principles of the patient-centered medical home. Delaware Medical Journal, 80, 21–22. American Academy of Family Physicians. (2008). Joint principles of the patient-centered medical home. Delaware Medical Journal, 80, 21–22.
Zurück zum Zitat American Psychiatric Association. (2005). APA gold award: Improving treatment engagement and integrated care of veterans. Psychiatric Services (Washington, DC), 10, 1306–1308. American Psychiatric Association. (2005). APA gold award: Improving treatment engagement and integrated care of veterans. Psychiatric Services (Washington, DC), 10, 1306–1308.
Zurück zum Zitat Bauer, M. S., Mcbride, L., Williford, W. O., Glick, H., Linosian, B., Altshuler, L., et al. (2006a). Collaborative care for bipolar disorder: Part 1. Intervention and implementation in a randomized effectiveness trial. Psychiatric Services (Washington, DC), 57, 927–936. doi:10.1176/appi.ps.57.7.927. Bauer, M. S., Mcbride, L., Williford, W. O., Glick, H., Linosian, B., Altshuler, L., et al. (2006a). Collaborative care for bipolar disorder: Part 1. Intervention and implementation in a randomized effectiveness trial. Psychiatric Services (Washington, DC), 57, 927–936. doi:10.​1176/​appi.​ps.​57.​7.​927.
Zurück zum Zitat Bauer, M. S., Mcbride, L., Williford, W. O., Glick, H., Linosian, B., Altshuler, L., et al. (2006b). Collaborative care for bipolar disorder: Part 2. Impact on clinical outcome, function, and costs. Psychiatric Services (Washington, D.C.), 57, 937–945. doi:10.1176/appi.ps.57.7.937. Bauer, M. S., Mcbride, L., Williford, W. O., Glick, H., Linosian, B., Altshuler, L., et al. (2006b). Collaborative care for bipolar disorder: Part 2. Impact on clinical outcome, function, and costs. Psychiatric Services (Washington, D.C.), 57, 937–945. doi:10.​1176/​appi.​ps.​57.​7.​937.
Zurück zum Zitat Butler, M., Kane, R. L., McAlpine, D., Kathol, R. G., Fu, S. S., Hadorn, H., et al. (2008). Integration of mental health/substance abuse and primary care. Agency of Healthcare Research and Quality Publication 09-E003. Rockville, MD. Butler, M., Kane, R. L., McAlpine, D., Kathol, R. G., Fu, S. S., Hadorn, H., et al. (2008). Integration of mental health/substance abuse and primary care. Agency of Healthcare Research and Quality Publication 09-E003. Rockville, MD.
Zurück zum Zitat Carels, R. A., Musher-Eizenman, D., Cacciapaglia, H., Perez-Benetiz, C. I., Christie, S., & O’Brien, W. (2004). Psychosocial functioning and physical symptoms in heart failure patients: A within-individual approach. Journal of Psychosomatic Research, 56, 95–101. doi:10.1016/S0022-3999(03)00041-2.PubMedCrossRef Carels, R. A., Musher-Eizenman, D., Cacciapaglia, H., Perez-Benetiz, C. I., Christie, S., & O’Brien, W. (2004). Psychosocial functioning and physical symptoms in heart failure patients: A within-individual approach. Journal of Psychosomatic Research, 56, 95–101. doi:10.​1016/​S0022-3999(03)00041-2.PubMedCrossRef
Zurück zum Zitat deGruy, F. V. (2006). A note on the partnership between psychiatry and primary care. American Journal of Psychiatry, 163, 1487–1489.PubMedCrossRef deGruy, F. V. (2006). A note on the partnership between psychiatry and primary care. American Journal of Psychiatry, 163, 1487–1489.PubMedCrossRef
Zurück zum Zitat Dietrich, A. J., Oxman, T. E., Williams, J. W., Schulberg, H. C., Bruce, M. L., Lee, P. W., et al. (2004). Reengineering systems for the treatment of depression in primary care: A cluster randomized controlled trial. British Medical Journal, 329, 602–608.PubMedCrossRef Dietrich, A. J., Oxman, T. E., Williams, J. W., Schulberg, H. C., Bruce, M. L., Lee, P. W., et al. (2004). Reengineering systems for the treatment of depression in primary care: A cluster randomized controlled trial. British Medical Journal, 329, 602–608.PubMedCrossRef
Zurück zum Zitat Doherty, W. J., McDaniel, S. H., & Baird, M. A. (1996). Five levels of primary care/behavioral healthcare collaboration. Behavioral Healthcare Tomorrow, 5, 25–28.PubMed Doherty, W. J., McDaniel, S. H., & Baird, M. A. (1996). Five levels of primary care/behavioral healthcare collaboration. Behavioral Healthcare Tomorrow, 5, 25–28.PubMed
Zurück zum Zitat Garcia-Shelton, L. (2002). Meeting US health care needs: A challenge for psychology. Professional Psychology Research and Practice, 37, 676–682.CrossRef Garcia-Shelton, L. (2002). Meeting US health care needs: A challenge for psychology. Professional Psychology Research and Practice, 37, 676–682.CrossRef
Zurück zum Zitat Goldberg, R. J. (1999). Financial incentives influencing the integration of mental health care and primary care. Psychiatric Services, 50, 1071–1075.PubMed Goldberg, R. J. (1999). Financial incentives influencing the integration of mental health care and primary care. Psychiatric Services, 50, 1071–1075.PubMed
Zurück zum Zitat Goldberg, R. J. (2002). Behavioral/primary care integration: A failed venture. Behavioral Healthcare Tomorrow, 11, 8–9.PubMed Goldberg, R. J. (2002). Behavioral/primary care integration: A failed venture. Behavioral Healthcare Tomorrow, 11, 8–9.PubMed
Zurück zum Zitat Grembowski, D. E., Martin, D., Patrick, D. L., Diehr, P., Katon, W., Williams, B., et al. (2002). Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms. Journal of General Internal Medicine, 12, 258–269.CrossRef Grembowski, D. E., Martin, D., Patrick, D. L., Diehr, P., Katon, W., Williams, B., et al. (2002). Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms. Journal of General Internal Medicine, 12, 258–269.CrossRef
Zurück zum Zitat Haas, L. J., & deGruy, F. V. (2005). Primary care, psychology and primary care psychology. In L. J. Haas (Ed.), Handbook of primary care psychology (pp. 5–19). New York: Oxford University Press. Haas, L. J., & deGruy, F. V. (2005). Primary care, psychology and primary care psychology. In L. J. Haas (Ed.), Handbook of primary care psychology (pp. 5–19). New York: Oxford University Press.
Zurück zum Zitat Hedrick, S. C., Chaney, E. F., Felker, B., Liu, F., Hasenberg, N. P., Heagerty, J., et al. (2003). Effectiveness of collaborative care depression treatment in Veterans’ Affairs primary care. Journal of General Internal Medicine, 18, 9–16.PubMedCrossRef Hedrick, S. C., Chaney, E. F., Felker, B., Liu, F., Hasenberg, N. P., Heagerty, J., et al. (2003). Effectiveness of collaborative care depression treatment in Veterans’ Affairs primary care. Journal of General Internal Medicine, 18, 9–16.PubMedCrossRef
Zurück zum Zitat Hegel, M., Unutzer, J., Tang, L., Arean, P. A., Katon, W. J., Hitchcock-Noel, P., et al. (2005). Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care. American Journal of Geriatric Psychiatry, 13, 48–58.PubMed Hegel, M., Unutzer, J., Tang, L., Arean, P. A., Katon, W. J., Hitchcock-Noel, P., et al. (2005). Impact of comorbid panic and posttraumatic stress disorder on outcomes of collaborative care for late-life depression in primary care. American Journal of Geriatric Psychiatry, 13, 48–58.PubMed
Zurück zum Zitat Institute of Medicine Board on Health Care Services. (2006). Improving the quality of health care for mental and substance-use conditions. Quality Chasm Series. Washington, DC: National Academies Press. Institute of Medicine Board on Health Care Services. (2006). Improving the quality of health care for mental and substance-use conditions. Quality Chasm Series. Washington, DC: National Academies Press.
Zurück zum Zitat Katon, W. J., Schoenbaum, M., Fan, M. Y., Callahan, C. M., Williams, J., Jr., Hunkeler, E., et al. (2005). Cost-effectiveness of improving primary care treatment of late-life depression. Archives of General Psychiatry, 62, 1313–1320.PubMedCrossRef Katon, W. J., Schoenbaum, M., Fan, M. Y., Callahan, C. M., Williams, J., Jr., Hunkeler, E., et al. (2005). Cost-effectiveness of improving primary care treatment of late-life depression. Archives of General Psychiatry, 62, 1313–1320.PubMedCrossRef
Zurück zum Zitat Kessler, R. (2005). Treating psychological problems in medical settings: Primary care as the defacto mental health system and the role of hypnosis. International Journal of Clinical and Experimental Hypnosis, 53, 290–305.PubMedCrossRef Kessler, R. (2005). Treating psychological problems in medical settings: Primary care as the defacto mental health system and the role of hypnosis. International Journal of Clinical and Experimental Hypnosis, 53, 290–305.PubMedCrossRef
Zurück zum Zitat Kessler, R. (2008). The difficulty of making psychology research and clinical practice relevant to medicine: Experience and observations. Journal of Clinical Psychology in Medical Settings, 15, 65–72.PubMedCrossRef Kessler, R. (2008). The difficulty of making psychology research and clinical practice relevant to medicine: Experience and observations. Journal of Clinical Psychology in Medical Settings, 15, 65–72.PubMedCrossRef
Zurück zum Zitat Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). The epidemiology of major depressive disorder: Results from the national comorbidity survey replication (NCS-R). Journal of the American Medical Association, 289, 3095–3105. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). The epidemiology of major depressive disorder: Results from the national comorbidity survey replication (NCS-R). Journal of the American Medical Association, 289, 3095–3105.
Zurück zum Zitat Kilbourne, A. M., Pincus, H. A., Schutte, K., Kirchner, J. E., Haas, G. L., &. Yano, E. M. (2006). Management of mental disorders in VA primary care practices. Administration and Policy in Mental Health and Mental Health Research, 33, 208–214. Kilbourne, A. M., Pincus, H. A., Schutte, K., Kirchner, J. E., Haas, G. L., &. Yano, E. M. (2006). Management of mental disorders in VA primary care practices. Administration and Policy in Mental Health and Mental Health Research, 33, 208–214.
Zurück zum Zitat Lipowski, Z. J. (1967). Review of consultation psychiatry and psychosomatic medicine: II. Clinical aspects. Psychosomatic Medicine, 29, 201–224.PubMed Lipowski, Z. J. (1967). Review of consultation psychiatry and psychosomatic medicine: II. Clinical aspects. Psychosomatic Medicine, 29, 201–224.PubMed
Zurück zum Zitat Lipowski, Z. J. (1974). Consultation-liaison psychiatry: An overview. American Journal of Psychiatry, 131, 623–630.PubMed Lipowski, Z. J. (1974). Consultation-liaison psychiatry: An overview. American Journal of Psychiatry, 131, 623–630.PubMed
Zurück zum Zitat Murray, M., & Berwick, D. (2003). Advanced access: Reducing waiting and delays in primary care. Journal of the American Medical Association, 289, 1035–1040. Murray, M., & Berwick, D. (2003). Advanced access: Reducing waiting and delays in primary care. Journal of the American Medical Association, 289, 1035–1040.
Zurück zum Zitat Ng, T. P., Niti, M., Tan, W. C., Cao, Z., Ong, K. C., & Eng, P. (2007). Depressive symptoms and chronic obstructive pulmonary disease: Effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Archives of Internal Medicine, 167, 60–67.PubMedCrossRef Ng, T. P., Niti, M., Tan, W. C., Cao, Z., Ong, K. C., & Eng, P. (2007). Depressive symptoms and chronic obstructive pulmonary disease: Effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Archives of Internal Medicine, 167, 60–67.PubMedCrossRef
Zurück zum Zitat Oslin, D. W., Ross, J., Sayers, S., Murphy, J., Kane, V., & Katz, I. (2006). Screening, assessment and management of depression in VA primary care clinics: The Behavioral Health Laboratory. Journal of General Internal Medicine, 21, 46–50.PubMedCrossRef Oslin, D. W., Ross, J., Sayers, S., Murphy, J., Kane, V., & Katz, I. (2006). Screening, assessment and management of depression in VA primary care clinics: The Behavioral Health Laboratory. Journal of General Internal Medicine, 21, 46–50.PubMedCrossRef
Zurück zum Zitat Oxman, T. E., Dietrich, A. J., & Schulberg, H. C. (2003). The depression care manager and mental health specialist as collaborators within primary care. American Journal of Geriatric Psychiatry, 11, 507–516. Oxman, T. E., Dietrich, A. J., & Schulberg, H. C. (2003). The depression care manager and mental health specialist as collaborators within primary care. American Journal of Geriatric Psychiatry, 11, 507–516.
Zurück zum Zitat Peryrot, M., & Rubin, R. R. (2007). Behavioral and psychosocial interventions in diabetes: A conceptual review. Diabetes Care, 30, 2433–2439. Peryrot, M., & Rubin, R. R. (2007). Behavioral and psychosocial interventions in diabetes: A conceptual review. Diabetes Care, 30, 2433–2439.
Zurück zum Zitat Pomerantz, A. S., Cole, B. H., Watts, B. V., & Weeks, W. B. (2008). Improving efficiency and access to mental health care: Combining integrated care and advanced clinical access. General Hospital Psychiatry, 30, 546–551.PubMedCrossRef Pomerantz, A. S., Cole, B. H., Watts, B. V., & Weeks, W. B. (2008). Improving efficiency and access to mental health care: Combining integrated care and advanced clinical access. General Hospital Psychiatry, 30, 546–551.PubMedCrossRef
Zurück zum Zitat Regier, D. A., Narrow, D. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto U.S. mental and addictive disorders service system: Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 50, 85–94.PubMed Regier, D. A., Narrow, D. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto U.S. mental and addictive disorders service system: Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry, 50, 85–94.PubMed
Zurück zum Zitat Schulberg, H. C. (2001). Treating depression in primary care practice: Applications of research findings. Journal of Family Practice, 50, 535–537.PubMed Schulberg, H. C. (2001). Treating depression in primary care practice: Applications of research findings. Journal of Family Practice, 50, 535–537.PubMed
Zurück zum Zitat Simon, G. E., Katon, W. J., VonKorff, M., Unutzer, J., Lin, E. H. B., Walker, E. A., et al. (2001). Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. American Journal of Psychiatry, 158, 1638–1644.PubMedCrossRef Simon, G. E., Katon, W. J., VonKorff, M., Unutzer, J., Lin, E. H. B., Walker, E. A., et al. (2001). Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. American Journal of Psychiatry, 158, 1638–1644.PubMedCrossRef
Zurück zum Zitat Skultety, K. M., & Zeiss, A. (2006). The treatment of depression in older adults in the primary care setting: An evidence based review. Health Psychology, 25, 665–674.PubMedCrossRef Skultety, K. M., & Zeiss, A. (2006). The treatment of depression in older adults in the primary care setting: An evidence based review. Health Psychology, 25, 665–674.PubMedCrossRef
Zurück zum Zitat Sledge, W. H., Moras, K., Hartley, D., & Levine, M. (1990). Effect of time limited psychotherapy on dropout rates. American Journal of Psychiatry, 147, 1341–1347.PubMed Sledge, W. H., Moras, K., Hartley, D., & Levine, M. (1990). Effect of time limited psychotherapy on dropout rates. American Journal of Psychiatry, 147, 1341–1347.PubMed
Zurück zum Zitat Smith, G. R., Monson, R. A., & Ray, D. C. (1986). Psychiatric consultation in somatization disorder: A randomized controlled study. New England Journal of Medicine, 314, 1407–1413.PubMed Smith, G. R., Monson, R. A., & Ray, D. C. (1986). Psychiatric consultation in somatization disorder: A randomized controlled study. New England Journal of Medicine, 314, 1407–1413.PubMed
Zurück zum Zitat Stanton, A. L., Revenson, T. A., & Tennen, H. (2007). Health psychology: Psychological adjustment to chronic illness. Annual Review of Psychology, 58, 565–592.PubMedCrossRef Stanton, A. L., Revenson, T. A., & Tennen, H. (2007). Health psychology: Psychological adjustment to chronic illness. Annual Review of Psychology, 58, 565–592.PubMedCrossRef
Zurück zum Zitat Strosahl, K. (1996). Mind and body: Primary mental healthcare: New model for integrated services. Behavioral Healthcare Tomorrow, 5, 93–95. Strosahl, K. (1996). Mind and body: Primary mental healthcare: New model for integrated services. Behavioral Healthcare Tomorrow, 5, 93–95.
Zurück zum Zitat Van Voorhees, B. W., Wang, N. Y., & Ford, D. E. (2001). Managed care and primary care physicians’ perception of patient access to high quality mental health services. Journal of General Internal Medicine, 16(Suppl 1), 200. Van Voorhees, B. W., Wang, N. Y., & Ford, D. E. (2001). Managed care and primary care physicians’ perception of patient access to high quality mental health services. Journal of General Internal Medicine, 16(Suppl 1), 200.
Zurück zum Zitat Van Voorhees, B. W., Wang, N. Y., & Ford, D. E. (2003). Managed care organizational complexity and access to high quality mental health services: Perspective of US primary care physicians. General Hospital Psychiatry, 25, 149–157.PubMedCrossRef Van Voorhees, B. W., Wang, N. Y., & Ford, D. E. (2003). Managed care organizational complexity and access to high quality mental health services: Perspective of US primary care physicians. General Hospital Psychiatry, 25, 149–157.PubMedCrossRef
Zurück zum Zitat Wagner, E. H., Austin, B. T., & VonKorff, M. (1996). Organizing care for patients with chronic illness. Milbank Quarterly, 74, 511–544.PubMedCrossRef Wagner, E. H., Austin, B. T., & VonKorff, M. (1996). Organizing care for patients with chronic illness. Milbank Quarterly, 74, 511–544.PubMedCrossRef
Zurück zum Zitat Wang, P. S., Demler, O., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2006). Changing profiles of service sectors used for mental health care in the United States. American Journal of Psychiatry, 163, 1187–1198.PubMedCrossRef Wang, P. S., Demler, O., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2006). Changing profiles of service sectors used for mental health care in the United States. American Journal of Psychiatry, 163, 1187–1198.PubMedCrossRef
Zurück zum Zitat Watts, B. V., Shiner, B., Pomerantz, A., Stender, P., & Weeks, W. B. (2007). Outcomes of a quality improvement project integrating mental health into primary care. Quality and Safety in Health Care, 16, 378–381.PubMedCrossRef Watts, B. V., Shiner, B., Pomerantz, A., Stender, P., & Weeks, W. B. (2007). Outcomes of a quality improvement project integrating mental health into primary care. Quality and Safety in Health Care, 16, 378–381.PubMedCrossRef
Metadaten
Titel
The Challenge of Integrated Care for Mental Health: Leaving the 50 minute hour and Other Sacred Things
verfasst von
Andrew S. Pomerantz
John A. Corson
Mark J. Detzer
Publikationsdatum
01.03.2009
Verlag
Springer US
Erschienen in
Journal of Clinical Psychology in Medical Settings / Ausgabe 1/2009
Print ISSN: 1068-9583
Elektronische ISSN: 1573-3572
DOI
https://doi.org/10.1007/s10880-009-9147-x

Weitere Artikel der Ausgabe 1/2009

Journal of Clinical Psychology in Medical Settings 1/2009 Zur Ausgabe