After receiving a diagnosis of infertility, a young woman commits suicide. Privately, she had been struggling with overwhelming despair - but her primary care physician had no idea. Despite the doctor’s good intentions, he was not trained to recognize or treat the depression that ultimately cost the young woman her life. Could suicide have been prevented if the doctor or someone on his team had been trained to address the young woman’s depression? He thought so.
Lo and behold, the “preventable tragedy” - something we all want to avoid. Though most doctors are trained to treat our physical ailments, without training in integrated care, they can often miss out on something significant: our mental health. The young woman’s suffering and suicide could have been avoided if even one of her doctors recognized the signs.
In current medical practice, patients are more frequently seeing a variety of specialists in an array of different settings. We see dozens of specialized physicians: Gastroenterologists, Hematologists, Endocrinologists, Rheumatologists, Gynecologists... The list goes on. While we can agree that receiving specialized treatment is important, there are pressing concerns that should be raised about the growing fragmentation of healthcare.
Comorbidity: It’s more common than we think
It is known that our bodies work as a whole. Our psychological health can have a staggering impact on the efficacy of medical treatment plans and overall physiological well-being. People with co-occurring physical and mental conditions represent a significant (and costly) portion of the population.
The issue, called comorbidity is the simultaneous presence of two chronic diseases or conditions in a patient. Having a mental disorder is a risk factor for developing a chronic condition, and having a chronic condition is a risk factor for developing a mental disorder. Ergo, mental disorders, and medical comorbidities are becoming increasingly prevalent, because of the interrelated nature of the problem.
An important driver of the high rate of comorbidity is the prevalence of chronic mental and physical disorders. About one in four Americans (25%) will struggle with a mental illness in a given year. Over half (58%) of the adult population will have a medical condition, and an estimated 68% of adults with mental disorders have medical conditions (Mental Disorders and Medical Comorbidity). Regarding instances of mental health, comorbidity is the rule rather than the exception.
Learning to Collaborate
We know that Behavioral Health can truly have a ‘make it or break it’ impact on medical modalities, recovery, and overall wellness. This is why developing an integrated healthcare approach is necessary, not just optimal for addressing complex medical issues. Without training in collaborative care, mental health problems can go undiagnosed or inadequately treated, medications can be inappropriately managed, and patients can incur a massive burden of both mental and physical suffering. The cumulative stress of both issues becomes greater than the sum of each issue.
The most efficient treatment for patients who suffer from mental and physical conditions involves collaborative care, which includes the use of a multidisciplinary team. When docs work collectively, they can successfully manage illness on all fronts, without undercutting each other. To work together, physicians do require a certain amount of collaborative training. It can be difficult to get physicians who do not traditionally work together to cooperate. To communicate effectively, they’ll need to rethink their roles to some extent. Without being trained, it can be difficult to maintain the collaborative infrastructure.
Cost and Benefits
So, is it financially feasible to integrate behavioral and primary health care?
Absolutely. Here’s why:
Interdisciplinary care is a long-term investment and the future of medicine. Since there is a strong relationship between psychological distress and medical service utilization, providing appropriate behavioral health services can reduce utilization, resulting in net savings to the health care system. While the amount of cost savings varies, the literature suggests that the provision of behavioral health services may be a major medical cost containment strategy. Savings in the vicinity of 20-40% are not uncommon for well-designed programs (Integrated Behavioral Health Care: An Effective and Affordable Model).
There are some promising models of integrated care that have truly been revolutionary. Programs like IMPACT, or Cherokee Health, and DIAMOND have been shown to be more than twice as effective as traditional depression care, while reducing overall healthcare costs. Furthermore, primary care programs like the one conducted by Harvard Medical School, are revealing improved patient outcomes when behavioral health and primary care are fused together. When you have primary care physicians who are not trained to diagnose or treat chronic mental health issues, ultimately it proves to be costlier. In the case of that young woman’s suicide, it was devastating.
So now what? Finding doctors who can work in integrated care is tricky.
Paramount to a good practice is physicians with the essential skillset to provide your patients with all necessary services towards better health. Medsource Consultants understands the benefit of a primary care practice collaborating with behavioral health and can source the right physicians for these select opportunities. In a country where integration has not fully developed within the primary care community, it’s a wise investment to your practice to get ahead and embrace the concept.