Treating Depression - Integrated Care

INTEGRATED CARE — In WNC, Meridian Behavioral Health and Appalachian Community Services are working with county health departments, to develop a more integrated system of care for individuals — combining mental health care and physical health care.

More frequently than ever before, the term “Integrated Care” is being used to talk about treatment options for individuals who have both physical and mental health needs. Integrated care combines primary health care and mental health care in one setting. There are different models or ways of integrating this care and sometimes this care goes by names such as “Collaborative Care” or "Health Homes."

In Western North Carolina, providers of mental health services such as Meridian Behavioral Health and Appalachian Community Services and physical health services including the county health departments, are working to develop a more comprehensive and integrated system of care for individuals receiving services.

This care is very important in treating the entire person. The National Institute of Health (NIH), believes that primary care settings, like a doctor's office, provide about half of all mental health care for common psychiatric disorders. Adults with serious mental illnesses and substance use disorders have higher rates of chronic physical illnesses and generally die earlier than the general population. And people with many common physical health conditions also have higher rates of mental health issues.

Providing Integrated Care helps both patients and their providers. It blends the expertise of mental health, substance use, and primary care clinicians, with feedback from patients and their caregivers. This creates a team-based approach where mental health care and general medical care are offered in the same setting. Coordinating primary care and mental health care in this way can help address the physical health problems of people with serious mental illnesses.

It is important to address the whole person and his or her physical and behavioral health if positive health outcomes and cost-effective care are to be achieved. Many people may not have access to mental health care or may prefer to visit their primary health care provider.

Although most primary care providers can treat some mental disorders, particularly through medication, that may not be enough for all patients. Historically, it has been difficult for a primary care provider to offer effective, high-quality mental health care when working alone. NIH states that combining mental health services/expertise with primary care can reduce costs, increase the quality of care, and, ultimately, save lives.

Untreated or undertreated mental illnesses have serious consequences. People with severe mental illness often die 13-30 years earlier than the general population from medical conditions that could have been treated by a primary care provider. Most children with mental health conditions are treated in a primary care setting initially instead of a specialized mental health setting. About half of all mental health disorders begin by age 14. So it is necessary to get an accurate diagnoses and quality care in a primary care setting to begin treatment at an earlier age.

Adults are also more likely to be seen in a primary care setting than within a mental health system. Primary care providers deliver half of the mental health care for common conditions such as anxiety, ADHD, depression, behavioral problems, and substance use.

People with mental illnesses, who are treated in a primary care setting, are less likely to receive effective behavioral health care. Seventy-five percent of adult patients with depression see primary care providers, but only half are accurately diagnosedper NIH data. When a referral is made to a mental health provider, only about half of patients follow through with making an appointment. As a result, many behavioral health problems go undetected, undertreated, and/or untreated.

Integrated Care meets all of a patient’s health needs in one setting. It can be delivered in multiple ways depending on which agency is providing the care, what type of care is being provided, where the care is taking place, and how services are being coordinated. Integration can take place in behavioral health, primary care, specialty clinics, and home health settings.

There are different levels of services integration. The Substance Abuse and Mental Health Service Administration (SAMHSA)designed a framework to help health care providers plan and support an integrated system. That framework has three main categories: Coordinated Care,which concentrates on communication; Co-located Care,which focuses on physical proximity; and Integrated Care,which emphasizes a true practice change.

For additional information visit or Call Meridian Behavioral Health at 828-631-3973.Health department information can be found on the web page for each county.


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