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Comprehensive Integrated Systems of Care

Designing Systems and Services for People with Co-occurring Conditions and Complex Needs

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Textbook of Community Psychiatry

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Abstract

The vision of community psychiatry is to organize services and systems to prioritize access for those “most in need and least able to pay.” Our understanding of who is “most in need” has evolved, and we recognize that those with poor outcomes, high costs, and difficulty with access and engagement are characterized as much by comorbidity and complexity as by severity in a single domain. Hence, our job in community psychiatry in the current decade is to organize services and systems for those “most in need” by virtue of their complexity. This “job” is often described as creating “integrated” systems for those with complex needs. However, although there are examples of success in components of integrated service delivery, we have not had a consistent framework for either design or implementation of comprehensive integrated systems that meet complex needs of people, communities, or populations. This chapter articulates such a framework and provides guidance to practitioners, administrators, and policy makers to make progress in the direction of universal implementation of comprehensive integrated systems for “those most in need due to complexity” who should be prioritized for access to services within available resources to best meet their needs for help and hope.

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Author information

Authors and Affiliations

  1. Zia Partners, Inc., Tucson, AZ, USA

    Kenneth Minkoff

  2. New York State Psychiatric Institute; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Nancy H. Covell

Authors
  1. Kenneth Minkoff
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  2. Nancy H. Covell
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Editor information

Editors and Affiliations

  1. Clinical Professor of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Wesley E. Sowers

  2. Clinical Professor of Psychiatry, New York University Grossman School of Medicine | NYU Langone Health, New York, NY, USA

    Hunter L. McQuistion

  3. Clinical Professor of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA

    Jules M. Ranz

  4. Professor Emerita of Psychiatry, Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA

    Jacqueline Maus Feldman

  5. Vice Chair/Professor, Department of Psychiatry, Case Western Reserve School of Medicine, Ohio, OH, USA

    Patrick S. Runnels

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Minkoff, K., Covell, N.H. (2022). Comprehensive Integrated Systems of Care. In: Sowers, W.E., McQuistion, H.L., Ranz, J.M., Feldman, J.M., Runnels, P.S. (eds) Textbook of Community Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-031-10239-4_7

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