34. Mental health is an equal component of a person’s overall health. Mental health directly impacts our physical health and our ability to recover from disease or medical interventions. Therefore, mental health needs to be deliberately and systematically integrated within the general healthcare system.
For historical reasons, healthcare has been arbitrarily divided into two separate but equal components – healthcare for your physical body and healthcare for your brain and emotional health. These two systems sit, side by side, with little integration or communication between them. Insurers and payers also treat them differently, as does the law. And far too many people believe they are separate because they diagnose and treat two things that aren’t related – your mind and your body.
However, as research has shown over the past six decades, the two are not separate. How you think impacts your health and your body. How you eat, exercise and sleep impact your brain and emotional health. The walls between this arbitrary distinction are starting to come down, but they need a greater focus on integration at every level between the two systems.
Physicians prescribe more antidepressant medications and other psychiatric medications than all other health professions – including psychiatrists – combined. This is of particular concern, since physicians’ training in mental health care is usually not on par with psychiatrists’ or other mental health professionals’. Due to their relentless schedules, most physicians also do little follow-up to ensure that the patient takes advantage of mental health referrals -- or even medication compliance.
We need to move beyond simply writing a script and a referral for emotional concerns. This is where integrated care comes in.
Joe’s Unintegrated Care Today
Let’s imagine a patient called Joe who has had a heart attack. He survives the attack, is hospitalized, and starts a regimen to tackle the underlying causes of the heart attack. The treatment plan includes medication, a change in diet, and a doctor’s order to “exercise more.” If Joe is like most Americans, he’ll go home, fill the prescription and maybe even start taking the medication. He may make a mild effort at changing his diet, cutting out the worst of his eating behaviors, but largely sticking to the same diet. The order to exercise will likely be ignored, or done a few times and then abandoned.
It does little good for a physician – even a well-meaning one – to prescribe behavioral changes to a patient without putting in place the necessary psychotherapeutic help and support to make those new habits stick. The lip service paid in today’s typical doctor’s office is to make a half-hearted referral to an outside professional – or worse, just suggest the patient find a therapist to talk to.
Joe’s Integrated Care Tomorrow
If Joe’s care were integrated, he’d immediately see a psychologist or similar mental health professional right there in the same doctor’s office, right after he saw his doctor. Things would be scheduled for Joe’s convenience and reinforce his sense of empowerment and that this is a well-integrated team there to help him. Joe’s psychologist would set up regular appointment times and help him learn the skills and strategies for effective habit change.
We also know that a positive attitude impacts patient outcomes after surgery. Patients with a negative attitude going into surgery experience longer hospital stays with more complications. Patients with a positive attitude are reward with just the opposite – shorter stays and less complications. So why don’t we integrate counseling into pre-surgery care? We’d reduce costs, complications and increase patient satisfaction, all by simply better integrating mental health care within our current healthcare system.
Integration Needs to Be Real, Not Just Lip Service
This integration needs to take place at the top in hospital and healthcare systems, as well as in family physician’s, general practitioner’s and internists’ practices. Psychologists and psychiatrists should become an integrated and valued member of the treatment team for many patients on their first visit. It shouldn’t be an afterthought, “Oh yeah, I guess you should probably see a therapist too.” Instead, the decision of when and how to introduce psychotherapy into the patient’s treatment plan should be dictated by the research, best practice and treatment guidelines.
The best healthcare systems and doctors will make mental health professionals equal to their physician colleagues, while putting the patient at the center of care. If the patient comes in for 10:00 for an appointment with their physician, they see their mental health professional at 10:30. In team treatment meetings, each patient is discussed by each professional, so everyone on the team has the same knowledge (instead of treating the patient in their own care silo).
There are enormous barriers to this sort of ideal care. Today, most physicians’ offices and healthcare systems don’t have mental health professionals on staff. Reimbursement may not line up exactly along the lines of what’s best for the patient’s overall treatment. And doctors would have to make more time for team treatment meetings. They’d also have to ensure each patient’s care isn’t just focusing on the physical complaint or disease, but thoughtfully and selectively inquire into their patient’s mental health as well.
Integrated care can be accomplished – I’ve seen it done successfully across the nation. But it takes real effort, systematic organizational changes, and a commitment to serving the best interests of the patient, regardless of the bottom line. In an ideal healthcare environment, mental health care would no longer be an afterthought – it would be understood as being equally important to treating the whole patient.