RESEARCH WEEKLY: Integrating Mental Health Treatment into Medical Care
By Elizabeth Sinclair Hancq
People with severe mental illness have high rates of co-morbid serious medical illnesses, such as cancer and heart failure, contributing to the 25-year gap in life expectancy compared to those without severe mental illness. Disparities in access to specialist care and discontinuity of psychiatric services when in treatment for serious medical illness contribute to worse prognoses and poorer outcomes in these individuals.
Similar to the benefits of integrating mental health care into primary care settings, there is a broad consensus among psychiatric policy experts that integrating psychiatric treatment into serious illness care can improve outcomes for individuals with co-morbid physical and psychiatric illness. However, in practice, much of psychiatric and medical care systems remain siloed.
The challenges for integrating mental health treatment into serious medical illness care are severalfold. Serious medical illness care is provided across multiple settings, including inpatient, outpatient and residential facilities, and a patient’s medical needs can sometimes be unpredictable or occur over short periods of time. Additionally, the serious medical illnesses themselves could be mental health stressors as an individual grapples with life-threatening illness and many medical treatment decisions.
COVID-19, the illness caused by infection from the novel SARS-CoV-2 virus that spread throughout the world starting in early 2020, brings another challenging dimension to the integration of mental health treatment into serious illness care. In addition to the potential long-lasting impacts of COVID-19 on people with severe mental illness, medical providers have had to adapt care models to address serious acute illness if an individual with COVID-19 experiences severe symptoms. At the same time, the mental health care delivery system was completely upended as treatment transitioned to virtual or telehealth services as much as possible.
Prior to the emergence of the COVID-19 pandemic, psychiatric policy researchers Daniel Shalev, M.D., and others from Weill Cornell Medicine proposed a conceptual framework to integrate mental health treatment into serious medical illness care. In an article published in Psychiatric Services this month, Dr. Shalev and his co-authors provide modifications to their original framework while discussing the opportunities for putting the framework into action as the COVID-19 pandemic begins to be a thing of the past.
Conceptual framework for mental health care integration
The key components of the framework for mental health care integration proposed by the authors are:
- care practices that are person- and family-centered,
- clinical functions that include longitudinal care management, family and caregiver support, and a workforce of interdisciplinary teams,
- clinical operation systems including health information exchanges, quality improvement and quality linkages, and
- payment and accountability policies that incentivize integration.
The authors note that the COVID-19 pandemic has further exacerbated health disparities, especially to racial/ethnic minority groups. Additionally, these populations are more likely to experience mental health complications during the COVID-19 pandemic and have a higher need for integrated mental health and serious illness medical care. Because of the impossibility of achieving integration without addressing these disparities, the study authors adapted their conceptual framework for mental health care integration to include promoting equity as a guiding principle for the model.
“Despite these challenges, COVID-19 may ultimately accelerate partnership between clinical and social service providers in the interest of improving care for high-need patients. Increased partnerships spearheaded by health systems could support these efforts,” the authors conclude. People with severe mental illness and co-morbid serious medical illnesses are some of the most vulnerable patients in the health care system. Further adaptations of the health care system to integrate psychiatric care into serious medical illness care can reduce health disparities and improve outcomes in this population.
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