Crossing The Divide: Primary Care And Mental Health Integration

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This paper describes the views of primary care providers about treating depression among adult Medicaid patients and their experiences with managed behavioral health care. It also shows the outcomes of an intervention project that provides a care manager to facilitate connections among PCPs, patients, and behavioral health providers. Despite widespread initiatives to improve depression management in primary care and to manage behavioral health services, it appears that links between the two systems and the use of evidence-based approaches to managing patients are rare. A pilot project to initiate practice redesign, the use of a care manager to assist in patient support, and compliance with both medical and behavioral health treatment has been shown to improve communication and results in positive patient outcomes. Managed behavioral health care can result in incentive structures that create gaps between primary care and behavioral health systems. This project illustrates an initiative co-sponsored by the Massachusetts behavioral health program designed to strengthen links between behavioral health and primary care, and increase rates and effectiveness of depression treatment.

Carole C. Upshur is a Professor in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School in Worcester, MA. This study was partially funded by the Robert Wood Johnson Foundation, Depression in Primary Care-Linking Clinical and Systems Strategies Initiative. Portions of this manuscript have been presented at: American Public Health Associate Annual Meeting, November, 2002, Philadelphia, PA; American Public Health Association, November, 2003, San Francisco, CA; and the Society for Teachers of Family Medicine, September, 2003, Atlanta, GA. The author would like to thank the entire Massachusetts Consortium on Depression in Primary Care for making contributions to the project and some of the ideas and data presented in this paper: Linda Weinreb, M.D., P.I., Gail Sawosik, M.B.A., Deborah Ruth Mockrin, L.I.C.S.W., Dan O’Donnell, M.D., Heidi Vermette, M.D., from the UMass Medical School team; Michael Norton, M.S.W., Co-P.I., Annette Hanson, M.D., former Co-P.I., Louise Bannister, J.D., R.N., Kate Staunton Rennie, M.P.A., from MassHealth; John Straus, M.D., Massachusetts Behavioral Health Partnership; Peg Johnson, M.D., Boston Medical Center Health Net Plan; Nancy Lafosse, M.S.W., Scot Sternberg, M.S., Network Health; and Thom Salmon, M.P.H., Neighborhood Health Plan. Address for correspondence: Carole C. Upshur, Professor, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. E-mail: