Abstract
Mental health and substance use disorders, in combination referred to as behavioral health, significantly impact lives across the world and represent a considerable proportion of the global disease burden. The intent of integration of physical and behavioral health is to increase access to services while promoting treatment of the whole person. Because many countries are undergoing transformation of their healthcare systems, this paper offers a comparative analysis of integrated models of behavioral healthcare between the USA, the UK, and China. Integrated care occurs on a spectrum, and therefore, this paper outlines micro-, mezzo-, and macro-level systems that illustrate both opportunities and challenges in integrated healthcare systems in the context of the three countries. Further, the authors provide evidence of the ways in which social work professionals are deployed in certain settings as part of the trained workforce that provides integrated behavioral health services. The discussion examines ways of leveraging the strengths of the social work workforce to improve holistic well-being worldwide.
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References
Alley, D. E., Asomugha, C. N., Conway, P. H., & Sanghavi, D. M. (2016). Accountable health communities—addressing social needs through Medicare and Medicaid. New England Journal of Medicine, 374(1), 8–11. https://doi.org/10.1056/NEJMp1512532.
Andrews, C. M., Darnell, J. S., McBride, T. D., & Gehlert, S. (2013). Social work and implementation of the Affordable Care Act. Health & Social Work, 38(2), 67–71. https://doi.org/10.1093/hsw/hlt002.
Bäck, M., & Calltorp, J. (2015). The Norrtaelje model: a unique model for integrated health and social care in Sweden. International Journal of Integrated Care, 15(6), 1–11. https://doi.org/10.5334/ijic.2244.
Berwick, D., Nolan, T., & Whittington, J. (2008). The Triple Aim: care, cost, and quality. Health Affairs, 27(3), 759–769. https://doi.org/10.1377/hlthaff.27.3.759.
British Association of Social Workers. (2009). Back to the very beginning. Professional Social Work. Retrieved from: http://cdn.basw.co.uk/upload/basw_123318-10.pdf
British Association of Social Workers. (n.d.). Social work careers. Retrieved from: https://www.basw.co.uk/social-work-careers/
Bronfenbrenner, U. (1979). The ecology of human development: experiments by nature and design. Cambridge, MA: Harvard University Press.
Cooper, A. (2017). Department of Health (U.K), Association of Directors of Adult Social Services & the Principal Social Workers’ Network (2017). Social work: essential to integration. Advice note. London: Department of Health (U.K), Retrieved from: https://tinyurl.com/y8qlk7en
Council on Social Work Education. (2014). HRSA behavioral health workforce education and training for professionals awardees [Press release]. Retrieved from http://www.hrsa.gov/grants/apply/assistance/behavioralhealth/
Cromarty, H. (2016). Social work regulation (England). (Briefing Paper No. CBP07802). House of Commons (U.K.). Retrieved from http://researchbriefings.files.parliament.uk/documents/CBP-7802/CBP-7802.pdf
Department of Health (U.K). (2016). Social work for better mental health: a strategic statement. Retrieved from https://tinyurl.com/j5m8v5r
Department of Health and Social Care (U.K.). (1999). National service framework for mental health: modern standards and service models. Retrieved from https://www.gov.uk/government/publications/quality-standards-for-mental-health-services
Department of Health and Social Care (U.K.). (2007). Quality and outcomes framework. Guidance—updated August 2004. Retrieved from http://webarchive.nationalarchives.gov.uk/20130103033600/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4088693.pdf
Fraser, M. W., Lombardi, B. M., Wu, S., de Saxe Zerden, L., Richman, E., & Fraher, E. (2018). Social work in integrated primary care: a systematic review. Journal for the Society of Social Work and Research, 9(2).
Gao, W. X. (2016). Zhong guo she gong fa zhan bao gao (2015) jie xuan [Reports on development of social work in China in 2015(excerpts)]. Gong yi shi bao [China Philosophy Times]. Retrieved from http://www.gongyishibao.com/newdzb/images/2016-03/08/10/GYSB10.pdf
Gao, J. G., & Yan, M. C. (2015). Social work in the making: the state and social work development in China. International Journal of Social Welfare, 24(1), 93–101. https://doi.org/10.1111/ijsw.12089.
Good, B. J., & Del Vecchio-Good, M. J. (2012). Significance of the 686 Program for China and for global mental health. Shang hai jing shen yi xue [Shanghai Archives of Psychiatry], 24(3), 175–177. doi: https://doi.org/10.3969/j.issn.1002-0829.2012.03.008.
Heath, B., Wise Romero, P., & Reynolds, K. (2013). A review and proposed standard framework for levels of integrated healthcare. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions. Retrieved from http://www.integration.samhsa.gov/integrated-care models/CIHS_Framework_Final_charts.pdf.
Hendry, A., Taylor, A., Mercer, S., & Knight, P. (2016). Improving outcomes through transformational health and social care integration: the Scottish experience. Healthcare Quarterly, 19(2), 73–79. https://doi.org/10.12927/hcq.2016.24703.
Kang, H., Guan, L., Wang, X., Wu, X., Ma, N., Li, S., ... Ma, H. (2015). “686 Xiang mu”31 ge shi fan shi (zhou) zhong xing ji bing huan zhe jing ji shui ping ji can bao zhi liao qing kuang fen xi [Analysis of the economic level, insurance, and treatment of patients with severe mental illness in 31 model cities in “686 Programme”]. Zhong guo gong gong wei sheng [Chinese Journal of Public Health], 31(8), 997–1001. doi:https://doi.org/10.11847/zgggws2015-31-08-06.
Kodner, D. L., & Spreeuwenberg, C. (2002). Integrated care: meaning, logic, applications, and implications—a discussion paper. International Journal of Integrated Care, 2(4), 1–6. https://doi.org/10.5334/ijic.67.
Lancet Global Mental Health Group. (2007). Scale up services for mental disorders: a call for action. Lancet, 370(9594), 1241–1252. https://doi.org/10.1016/S0140-6736(07)61242-2.
Leutz, W. N. (1999). Five laws for integrating medical and social services: lessons from the United States and the United Kingdom. Milbank Quarterly, 77(1), 77–110. https://doi.org/10.1111/1468-0009.00125.
Li, Y., Han, W. J., & Huang, C. C. (2012). Development of social work education in China: background, current status, and prospects. Journal of Social Work Education, 48(4), 635–653. https://doi.org/10.5175/JSWE.2012.201100049.
Liang, D., Wang, Q., & Ying, X. H. (2011). Wo guo jing shen zhang ai yi liao bao xian zheng ce xian zhuang fen xi [Analysis on status quo of medical insurance policies on mental disorders in China]. Zhong guo wei sheng zheng ce yan jiu [Chinese Journal of Health Policy], 4(7), 46–50. https://doi.org/10.3969/jissn1674-2982.2011.07.010.
Liang, D., Mays, V. M., & Hwang, W. C. (2017). Integrated mental health services in China: challenges and planning for the future. Health Policy and Planning, 33(1), 107–122. https://doi.org/10.1093/heapol/czx137.
Liu, J., Ma, H., He, Y. L., Xie, B., Xu, Y. F., Tang, H. Y., ... Ng, C. H. (2011). Mental health system in China: history, recent service reform and future challenges. World Psychiatry, 10(3), 210–216. doi:https://doi.org/10.1002/j.2051-5545.2011.tb00059.x.
Ma, H., Liu, J., & Yu, X. (2009). Zhong guo jin shi nian zhong yao jing shen wei sheng zheng ce de fa zhan yu jie du [Analysis of China’s mental health policy development in recent 10 years]. Zhong guo xin li wei sheng za zhi [Chinese Mental Health Journal], 23, 840–843. https://doi.org/10.3969/jissn.1000-6729.2009.12.002.
Ministry of Civil Affairs (CN). (2016). 2016 she hui fu wu fa zhan tong ji gong bao [Statistical communique on social service development in 2016]. Retrieved from http://www.mca.gov.cn/article/sj/tjgb/201708/20170800005382.shtml
National Archives (UK). (2012). Health and social care act explained. Retrieved from http://webarchive.nationalarchives.gov.uk/20130104160219/http://healthandcare.dh.gov.uk/act-factsheets
Office of Economic Cooperation and Development. (2017). Health at a glance 2017: OECD indicators. Paris: OECD Publishing. doi: https://doi.org/10.1787/health_glance-2017-en
Pan, Y. (2017, March 23). 76 wan zhuan ye she gong bian bu cheng xiang she hui gong zuo fu wu min sheng chuan di wen nuan [760,000 professional social workers throughout the urban and rural provide social work service]. Ren min ri bao [Renmin Daily]. Retrieved from http://www.mca.gov.cn/article/yw/shgzyzyfw/mtgz/201703/20170300003853.shtml
Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 et seq. (2010).
Peek, C. J., & National Integration Academy Council. (2013). Lexicon for behavioral health and primary care integration: concepts and definitions developed by expert consensus (AHRQ Publication No.13-IP001-EF). Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://integrationacademy.ahrq.gov/sites/default/files/Lexicon.pdf
Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. Journal of Health and Social Behavior, 51(1_suppl), S28–S40. https://doi.org/10.1177/0022146510383498.
Phillips, M. R., Zhang, J., Shi, Q., Song, Z., Ding, Z., Pang, S., et al. (2009). Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001–05: an epidemiological survey. Lancet, 373(9680), 2041–2053. https://doi.org/10.1016/S0140-6736(09)60660-7.
Saxena, S., Funk, M., & Chisholm, D. (2013). World Health Assembly adopts comprehensive mental health action plan 2013–2020. Lancet, 381(9882), 1970–1971. https://doi.org/10.1016/S0140-6736(13)61139-3.
Stanhope, V., Videka, L., Thorning, H., & McKay, M. (2015). Moving toward integrated health: an opportunity for social work. Social Work in Health Care, 54(5), 383–407. https://doi.org/10.1080/00981389.2015.1025122.
State Council (CN). (2015).Quan guo jing shen wei sheng gong zuo gui hua (2015–2020) [National Mental Health Working Plan (2015–2020)].Retrieved from http://www.gov.cn/zhengce/content/2015-06/18/content_9860.htm
Steketee, G., Ross, A. M., & Wachman, M. K. (2017). Health outcomes and costs of social work services: a systematic review. American Journal of Public Health, 107(S3), S256–S266. https://doi.org/10.2105/AJPH.2017.304004.
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2014). Healthy people 2020. Retrieved from https://www.cdc.gov/dhdsp/hp2020.htm
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (2006). Mental health, United States 2004. Retrieved from: https://store.samhsa.gov/shin/content/SMA06-4195/SMA06-4195.pdf
Valentijn, P. P., Schepman, S. M., Opheij, W., & Bruijnzeels, M. A. (2013). Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. International Journal of Integrated Care, 13(1), 1–12. https://doi.org/10.5334/ijic.886.
van der Klauw, D., Molema, H., Grooten, L., & Vrijhoef, H. (2014). Identification of mechanisms enabling integrated care for patients with chronic diseases: a literature review. International Journal of Integrated Care, 14(3), 1–10. https://doi.org/10.5334/ijic.1127.
Wen, J., & Liu, X. (2015). Jin ba nian yi lai zhong guo she hui gong zuo yan jiu de hui gu yu fan si [The retrospect and introspection of China social work research from 2007]. Hua dong li gong da xue xue bao (she hui ke xue ban) [Journal of East China University of Science and Technology (Social Science Edition)], 6, 1–12. https://doi.org/10.3969/j.issn.1008-7672.2015.06.001.
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., et al. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet, 382(9904), 1575–1586. https://doi.org/10.1016/S0140-6736(13)61611-6.
World Health Organization. (2001). World Health Report 2001: mental health: new understanding, new hope. Geneva, Switzerland: Author. Retrieved from http://www.who.int/whr/2001/en/
World Health Organization. (2008a). Mental Health Gap Action Program (mhGAP): scaling up care for mental, neurological, and substance use disorders. Geneva: Switzerland: Author.
World Health Organization. (2008b). Integrated health services—what and why? (technical brief no. 1). Retrieved from http://www.who.int/healthsystems/service_delivery_techbrief1.pdf
World Health Organization. (2008c). Integrating mental health into primary care: a global perspective. Retrieved from http://www.who.int/mental_health/resources/mentalhealth_PHC_2008.pdf
World Health Organization. (2013). Draft comprehensive mental health action plan 2013–2020. Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_10Rev1-en.pdf
World Health Organization. (2017). Depression and other common mental disorders global health estimates. Retrieved from http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf
Yip, W., & Hsiao, W. (2014). Harnessing the privatisation of China’s fragmented health-care delivery. Lancet, 384(9945), 805–818. https://doi.org/10.1016/S0140-6736(14)61120-X.
Yuen-Tsang, A. W., & Wang, S. (2002). Tensions confronting the development of social work education in China: challenges and opportunities. International Social Work, 45(3), 375–388. https://doi.org/10.1177/0020872802045003366.
Zhang, Y., Ma, N., Ma, H., Chen, J., Guan, L., Zhu, Y., Xie, B., …, Li, K. (2014). Nong cun di qu zhong xing jing shen ji bing guan li zhi liao yi ti hua ren li zi yuan pei zhi biao zhun ji fen dang fu wu nei rong yan jiu [Human resource allocation standard of psychosis treatment and management and grading services in rural areas].Zhong guo quan ke yi xue [Chinese General Practice], 17, 2674–2679. doi:https://doi.org/10.3969/j.issn.1007-9572.2014.23.003.
Zhu, Y., Zhang, W., Wang, Y., & Cai, J. (2014). Providing free treatment for severe mental disorders in China. Shanghai Archives of Psychiatry, 26(2), 101–102. https://doi.org/10.3969/j.issn.1002-0829.2014.02.007.
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de Saxe Zerden, L., Lombardi, B.M. & Guan, T. Integrated Behavioral Health and Social Work: a Global Perspective. Glob Soc Welf 6, 49–56 (2019). https://doi.org/10.1007/s40609-018-0114-z
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DOI: https://doi.org/10.1007/s40609-018-0114-z