The Next Step in Integrated Care: Universal Primary Mental Health Providers
- 179 Downloads
Current models of mental health care often do not address three barriers to mental health: the binary view of mental illness (healthy vs. mentally ill), stigma, and prevention. Care models where some patients are selected for referral or consultation with a mental health professional can reinforce this binary view and the stigma associated with seeing mental health services. By only selecting patients who currently are experiencing mental health problems, current integrated care models do not offer sufficient avenues for prevention. To address these barriers, this article proposes building on current models through the development of primary mental health providers (PMHPs). PMHPs—like primary care providers—would provide regular check-ups, assessments, prevention interventions, first-line treatment, or referral to more specialized professionals. This universal approach will help decrease the binary view of mental health, decrease the stigma of seeing a mental health professional through universal access, and improve prevention efforts.
KeywordsIntegrated care Mental health Prevention Stigma Behavioral health
Compliance with Ethical Standards
Conflict of interest
The author Adrienne A. Williams declares that she has no conflict of interest.
Human and Animal Rights
This article does not contain any studies with human participants or animals performed by any of the authors.
This article does not contain any studies with human participants performed by any of the authors.
- Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., & Solberg, L. I. (2014). Health care contacts in the year before suicide death. Journal of General Internal Medicine, 29, 870–877. https://doi.org/10.1007/s11606-014-2767-3.CrossRefPubMedPubMedCentralGoogle Scholar
- American Psychological Association. (2015). APA professional and clinical practice guidelines. Retrieved August 20, 2015, from http://www.apa.org/about/offices/directorates/guidelines/index.aspx.
- American Psychological Association Office of Health Care Financing Staff. (2015). Do you know about these 2015 coding changes? Retrieved March 12, 2019, from https://www.apaservices.org/practice/update/2015/02-26/coding-changes.
- Anderson, N. B. (Ed.). (2014). Special issue: Primary care and psychology. American Psychologist: Journal of the American Psychological Association, 69, 325–451.Google Scholar
- Association of American Medical Colleges. (2019). Required interprofessional education. Retrieved March 8, 2019, from https://www.aamc.org/initiatives/cir/403572/02.html.
- Basu, S., Landon, B. E., Williams, J. W., Jr., Bitton, A., Song, Z., & Phillips, R. S. (2017). Behavioral health integration into primary care: A microsimulation of financial implications for practices. Journal of General Internal Medicine, 32, 1330–1341. https://doi.org/10.1007/s11606-017-4177-9.CrossRefPubMedPubMedCentralGoogle Scholar
- Beronio, K., Po, R., Skopec, L. & Glied, S. (2013). Affordable care act expands mental health and substance use disorder benefits and federal parity protections for 62 million Americans. Retrieved March 3, 2019, from https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parity-protections-62-million-americans.
- Branson, B. M., Handsfield, H. H., Lampe, M. A., Janssen, R. S., Taylor, A. W., Lyss, S. B., … Centers for Disease Control and Prevention (CDC). (2006). Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports/centers for disease control, 55, 1–17. (quiz CE1-4).Google Scholar
- Bryan, C. J., Corso, M. L., Corso, K. A., Morrow, C. E., Kanzler, K. E., & Ray-Sannerud, B. (2012). Severity of mental health impairment and trajectories of improvement in an integrated primary care clinic. Journal of Consulting and Clinical Psychology, 80, 396–403. https://doi.org/10.1037/a0027726.CrossRefPubMedGoogle Scholar
- Bureau of Labor Statistics. (2018). Occupational employment statistics: May 2017 national occupational employment and wage estimates united states. Retrieved March 11, 2019, from https://www.bls.gov/oes/current/oes_nat.htm.
- Carnevale, A. P., Rose, S. J. & Cheah, B. (n.d.). The college payoff: Education, occupations, lifetime earnings. Retrieved March 10, 2019, from https://www2.ed.gov/policy/highered/reg/hearulemaking/2011/collegepayoff.pdf.
- Cassels, C. (2013). DSM-5 officially launched, but controversy persists. Retrieved July 16, 2013, from http://www.medscape.com/viewarticle/804410.
- Centers for Disease Control and Prevention (CDC). (2013). Polio. Retrieved July 30, 2015, from http://www.cdc.gov/vaccines/vpd-vac/polio/downloads/dis-polio-color-office.pdf.
- Centers for Disease Control and Prevention (CDC). (2014). Cervical cancer statistics. Retrieved July 30, 2015, from http://www.cdc.gov/cancer/cervical/statistics/index.htm.
- Chaffee, B. (2009). Financial models for integrated behavioral health. In L. C. James, & W. T. O’Donohue (Eds.), The primary care toolkit: Practical resources for the integrated behavioral care provider (pp. 19–30, Chapter xii, 333 Pages). New York, NY: Springer.Google Scholar
- Clark, E. G., & Leavell, H. R. (1965). Levels of application of preventive medicine. In H. R. Leavell & E. G. Clark (Eds.), Preventive medicine for the doctor in his community (3rd ed., pp. 14–38). New York: McGraw-Hill Book Company.Google Scholar
- Dueweke, A. R., Marin, M. S., Sparkman, D. J., & Bridges, A. J. (2018). Inadequacy of the PHQ-2 depression screener for identifying suicidal primary care patients. Families, Systems & Health: The Journal of Collaborative Family Healthcare, 36, 281–288. https://doi.org/10.1037/fsh0000350.CrossRefGoogle Scholar
- Englander, R., Cameron, T., Ballard, A. J., Dodge, J., Bull, J., & Aschenbrener, C. A. (2013). Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine, 88, 1088–1094. https://doi.org/10.1097/ACM.0b013e31829a3b2b.CrossRefPubMedGoogle Scholar
- Germán, M., Rinke, M. L., Gurney, B. A., Gross, R. S., Bloomfield, D. E., Haliczer, L. A., & Briggs, R. D. (2017). Comparing two models of integrated behavioral health programs in pediatric primary care. Child and Adolescent Psychiatric Clinics of North America, 26, 815–828. https://doi.org/10.1016/j.chc.2017.06.009.CrossRefPubMedGoogle Scholar
- Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. New York: Touchstone.Google Scholar
- Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York, NY: Guilford Press.Google Scholar
- Hunter, C. L., Dobmeyer, A. C., & Reiter, J. T. (2018a). Integrating behavioral health services into primary care: Spotlight on the primary care behavioral health (PCBH) model of service delivery. Journal of Clinical Psychology in Medical Settings, 25, 105–108. https://doi.org/10.1007/s10880-017-9534-7.CrossRefPubMedGoogle Scholar
- Hunter, C. L., Reiter, J. T., & Dobmeyer, A. C. (Eds.). (2018). Special issue: The primary care behavioral health model of integration. Journal of Clinical Psychology in Medical Settings, 25, 105–236.Google Scholar
- Kaltiala-Heino, R., & Rimpelä, A. (1999). Are mental health promotion and prevention of mental disorders in adolescence worthwhile? Psychiatria Fennica, 30, 225–243.Google Scholar
- Katz, D. L., & Ali, A. (2009). Preventive medicine, integrative medicine & the health of the public. Retrieved November 13, 2014, from http://www.iom.edu/~/media/Files/Activity%20Files/Quality/IntegrativeMed/Preventive%20Medicine%20Integrative%20Medicine%20and%20the%20Health%20of%20the%20Public.pdf.
- Khatri, P., Perry, G., & deGruy, F. V., III. (2017). Integrated health care at Cherokee Health Systems. In R. E. Feinstein, J. V. Connelly, & M. S. Feinstein (Eds.), Integrating behavioral health and primary care (pp. 17–30). New York, NY: Oxford University Press.Google Scholar
- Kilian, R., Losert, C., Park, A., McDaid, D., & Knapp, M. (2010). Cost-effectiveness analysis in child and adolescent mental health problems: An updated review of literature. International Journal of Mental Health Promotion, 12, 45–57. https://doi.org/10.1080/14623730.2010.9721825.CrossRefGoogle Scholar
- Leavell, H. R., & Clark, E. G. (1965). Preventive medicine for the doctor in his community: An epidemiologic approach. New York: McGraw-Hill.Google Scholar
- Melek, S. P. (2012). Bending the Medicaid healthcare cost curve through financially sustainable medical-behavioral integration. Retrieved September 24, 2018, from http://www.milliman.com/uploadedFiles/insight/health-published/pdfs/bending-medicaid-cost-curve.pdf.
- National Alliance on Mental Illness. (2019). What is mental health parity? Retrieved March 7, 2019, from https://www.nami.org/find-support/living-with-a-mental-health-condition/understanding-health-insurance/what-is-mental-health-parity.
- Petersen, I., Barry, M., Lund, C., & Bhana, A. (2014). Mental health promotion and the prevention of mental disorders. New York, NY: Oxford University Press.Google Scholar
- Rowan, A. B., & Runyan, C. N. (2005). A primer on the consultation model of primary care behavioral health integration. In L. C. James & R. A. Folen (Eds.), The primary care consultant: The next frontier for psychologists in hospitals and clinics (pp. 9–27). Washington, DC: American Psychological Association. https://doi.org/10.1037/10962-001.CrossRefGoogle Scholar
- SAMHSA-HRSA Center for Integrated Health Solutions. (2014). Integrating behavioral health into primary care. Retrieved November 6, 2014, from http://www.integration.samhsa.gov/integrated-care-models/behavioral-health-in-primary-care#integrated%20models%20of%20BH%20in%20PC.
- Silberner, J. (2017). The doctor will analyze you now. Politico. Retrieved September 21, 2018, from https://www.politico.com/agenda/story/2017/08/09/mental-illness-primary-care-000486.
- U.S. Food and Drug Administration. (2014). FDA: Don’t leave childhood depression untreated. FDA Consumer Health Information, (September 2014). Retrieved February 17, 2015, from http://www.fda.gov/forconsumers/consumerupdates/ucm413161.htm.
- Wong, E. C., Schell, T. L., Marshall, G. N., Jaycox, L. H., Hambarsoomians, K., & Belzberg, H. (2009). Mental health service utilization after physical trauma: The importance of physician referral. Medical Care, 47, 1077–1083. https://doi.org/10.1097/MLR.0b013e3181a80fc9.CrossRefPubMedPubMedCentralGoogle Scholar
- World Health Organization. (1978). Declaration of Alma-Ata. Paper presented at the International Conference on Primary Health Care, Alma-Ata, USSR. (September 6–12). Retrieved February 2, 2015, from http://www.who.int/publications/almaata_declaration_en.pdf.
- World Health Organization. (2005). Constitution of the World Health Organization. Retrieved November 6, 2014, from http://www.who.int/governance/eb/constitution/en/.
- World Health Organization. (2014). WHO called to return to the declaration of Alma-Ata. Retrieved November 6, 2014, from http://www.who.int/social_determinants/tools/multimedia/alma_ata/en/.