by Sunita Mutha, MD, FACP, Healthforce Center at UCSF Director
Last week, I saw a patient, let’s call him Al. Al has two kids and a wife, and recently lost his job. Though he was able to find a new position, he continuously worries that he will be laid off again and this is now interfering with his daily life. As Al’s primary care physician, I used a standardized tool to diagnose moderately severe anxiety. Though I can suggest a treatment plan based on evidence, I cannot easily offer him a referral to a trusted behavioral health practitioner in his network (like I can for other specialty care), and I cannot have confidence that he will be seen quickly and start the treatment he so needs.
The systemic barriers between behavioral health and primary care are prevalent, the results can be deadly, but promising models for integration could put us on the right path.
The Costs and Barriers
Failure to properly treat Al – and others with mental health disorders—isn’t just a matter of discomfort, but can be the difference between life or death. People from ancient civilizations were convinced, and science has since proven, that the body and the mind are intricately connected. It seems so obvious— they are part of the same system, but our modern medical system has not yet caught up. As a result, both the human and financial costs are staggering:
- An estimated 43.8 million adults in the US had a mental illness in 2013, representing 18.5 percent of all US adults.
- Treatment of chronic physical health issues for patients with behavioral health needs is two to three times more costly than for patients with only physical health needs.
- The top drivers of total health costs are either behavioral health conditions or illnesses that can be greatly exacerbated by mental health issues: depression, anxiety, obesity, back and neck pain, and arthritis.
- Each year, more than 42,000 Americans die by suicide.
Although the Affordable Care Act includes a push to integrate behavioral health and primary care, the barriers to integration may also seem staggering: insurance and payment issues, conflicting treatment cultures, stigma and workforce issues have significantly slowed progress in this area.
Models for Integration
We’ve seen promising signs, in our leadership programs and workforce research, that integration is possible when it is prioritized.
Dr. Peter Currie, senior director of clinical transformation & integration with Inland Empire Health Plan, graduated from our California Healthcare Foundation Healthcare Leadership Program in 2014. Peter drew on his new skills and knowledge to lead several successful initiatives to integrate behavioral health and primary care by establishing a non-profit center for assessing autism in children in the Inland Empire region. He also piloted a program for providing an intensive outpatient program for severely mentally ill patients, which reduced emergency department visits and psychiatric bed days, producing an average 25 percent savings in costs. In addition, he partnered with his chief medical officer to author a letter outlining the gaps in mental health care for the Medicaid population in California and asking the state to provide mental health benefits to fill those gaps. Medical officers of other plans across the state signed the letter, which led the California Department of Healthcare Services to expand benefits in 2014. In the first quarter of that year, Peter authorized nearly 60,000 mental health visits to members who previously had no access to treatment.
Efforts like the Greater Bay Area Mental Health and Education Workforce Collaborative, have managed to cut across counties, agencies, organizations, and institutions, to expand the Bay Area's public mental health workforce and come up with meaningful solutions to meet the needs of the people living here. For example, the collaborative has helped integrate psychosocial rehabilitation curriculum into the California Association of Social Rehabilitation Agencies and participated in state policy making and advisory committees.
I see dozens of patients like Al every month—people suffering from anxiety, depression and other mental health disorders. Integrating behavioral health with primary care is the best way forward. Achieving this promise requires leaders and innovators from across the workforce coming together to prioritize the whole health of all Americans. I’m hopeful that we can do it sooner rather than later.
About Dr. Mutha: Dr. Sunita Mutha, MD, FACP, is the director of Healthforce Center at UCSF. For over a decade, Dr. Mutha has been engaged in leadership development for health professionals with a special focus on emerging leaders and inter-professional training.