Five years ago, I had a family member struggling with depression. The medication they had been taking wasn’t effective anymore. They visited their primary care provider, who said they should see a psychiatrist and handed over a piece of paper with four names and phone numbers. Once at home, my family member made four calls and learned that none of the psychiatrists were taking new patients. They were back to square one, except now feeling that even their own doctor couldn’t assist them. After several months and the help of other relatives, they were able to connect with a psychiatrist who was taking new patients. That psychiatrist never communicated with their primary care provider to gather a medical history or share new treatment plans.
This was a stark and personal lesson about the consequences of a disjointed medical system — a system that has long separated and siloed the mind and the body. Fortunately for my family member, they had privilege, resources and a supportive extended family to help them through the system. Many others are not as fortunate, experiencing the negative health outcomes associated with this kind of poorly coordinated care.
- Approximately 30 million people receive a psychotropic medication prescription each year (mostly in primary care), but only 1 in 4 of them improve.
- Patients with serious mental illness die 10-20 years earlier, often due to insufficient medical care for largely preventable diseases.
- In Washington state, where I live, 1,292 people died by suicide in 2017. That’s more than three people per day, every day of the year.
During my five years at Comagine Health, I’ve been able to focus on one of my passion areas: improving the integration and coordination of behavioral and physical health. I’ve witnessed and contributed to the progress and connections made as my state moves toward a system of truly integrated care:
- Through development of the Behavioral Health Integration Implementation Guide (in partnership with the AIMS Center at the University of Washington)
- Through work as the Practice Transformation Support Hub to support providers in bidirectional integration (behavioral health into primary care settings and physical health into behavioral health settings)
Behavioral health integration is not a one-size-fits-all solution. It requires creativity and resourcefulness, and it must be structured in a way that fits the health system and community it services. When it is well executed, the impacts for both patients and providers can be significant, reducing provider burden while giving patients the holistic support necessary to successfully manage their mental and physical health needs.
Integrated care is truly team-based care, and it often expands the team outside the walls of the primary care clinic. I’ve had the opportunity to see this care in action around my state, and it never fails to inspire me. As Washington removes barriers and creates increasing incentives for providers to deliver integrated care, I am excited to see where health outcomes go!