Integrating Health and Mental Health Services in the US / Integración de la Salud y Servicios de Salud Mental en los EE.UU
International Journal of Integrated Care
A review of factors that impact on health indicate that access to clinical health care services accounts for less than 15% of health outcome, while social and environmental factors such as housing and food supply determine 40% of health, and health behaviors account for 35% of health, with the remaining variance is accounted for by genetics. If progress is to be made, behavioral health needs, including addressing the domains of health behaviors, such as smoking, sedentary behavior and poor
... avior and poor diet; treatment of diagnosable mental health conditions, and substance abuse must be effectively integrated into primary care. Data from the US indicate that providing treatment during years lived with chronic health conditions now accounts for the majority of health care costs. Further, it has also been well documented that people who have chronic health conditions are much more likely to also have co-morbid depression and anxiety. Patients who have dual health and mental health or substance abuse diagnoses tend to have higher (50% or more) health care costs, particularly when their behavioral conditions are not treated. Effective treatment for those patients must include well coordinated health and mental health services. Prospective studies have shown that treatment of co-morbid conditions results in improved health and satisfaction with treatment. Thus, to address the three major domains of behavioral health (health behaviors, mental health conditions, substance abuse) requires a multi faceted approach that recognizes the contribution of behavioral factors to health. These includes public health and community campaigns to reduce smoking, improve diet and increase physical activity in a healthy population at risk due to behavior. The second tier for intervention for integrated primary care to address the needs of patients who have the highest need, those with co-morbid health and mental health conditions. Full integration of health, mental health and substance abuse services will include team based coordinated practice, and sharing of information through electronic health records. For the patients who have the highest level of complexity, development of coordinated care plans is an essential step.