Integrated Behavioral Healthcare

After many years of concern with our fragmented health delivery system, there is currently intense interest in combining the two silos of physical health and mental health into one integrated system in which behavioral health is an integral, seamless part of primary care.

It has been known for many years that 60 to 70 percent of physician visits are by patients without a physical illness whose symptoms reflect somatized stress and emotional distress, or whose actual physical illness is being exacerbated by psychological problems. Most of such patients are only partially identified by their physicians, who usually expend time and resources in an attempt to discern a non-existent medical diagnosis, thus missing the somatization, depression, anxiety and other forms of emotional distress that are mimicking physical disease. Additionally, patients with chronic physical illnesses are plagued with depression, non-compliance with medical regimens, and exacerbation of pain and physical discomfort. Finally, stress, life style problems (lack of exercise, smoking), and treatment noncompliance contribute greatly to health problems and thus healthcare costs.

Disease management programs, which essentially parachute a quasi-behavioral treatment approach, usually lack sufficiently sophisticated assessments and interventions and have yielded disappointing results. On the other hand, fully integrated systems result in reducing medical dollars by appropriate, targeted behavioral interventions for the psychologically distressed population. Called the medical cost offset effect, this has been demonstrated in a variety of healthcare systems.

The national and international healthcare crisis call for new more efficient healthcare delivery systems. Psychologists working within the physical medical delivery system can offer more comprehensive and more efficient assessment and treatment. These psychologists need special skill sets in order to be medically literate, work within a fast paced, action oriented delivery system and be able to treat problems that go beyond DSM diagnoses such as treatment non compliance and chronic disease management. Studies have shown that patients are more satisfied with these integrated systems, physicians can work more efficiently in them, patient health is improved and total medical costs are reduced.

This concept of integrated healthcare has been endorsed by the World Health Organization, the Institute of Medicine, the Presidential New Freedom Commission and by the American Psychological Association.