• Dr. Romi Fung, ND

Integrated Mental Healthcare Post #3: Avoiding Fragmentation of Health Services

Updated: Dec 7, 2019

There are roles that an integrated mental healthcare system can provide. It implies a comprehensive service, which includes the integration of mental health care into the primary health care system. Furthermore, mental health care is conceptualized more broadly than psychiatric care to include care for non-psychiatric mental health problems as well as the promotion of mental health. (Petersen, 2000) There are signs and symptoms that can be seen as a physical abnormality such as low energy, weight gain or hypersomnia when in fact can be a sign of depression (Horgan, 2019). These can be recognized by primary healthcare practitioners and be dealt with in the screening, prevention and promotion of mental health.

In this video, Dr. Radha Kambhampati talks about how there are symptoms and disorders. Symptoms are not disabling. He shares his medical team including internalists, medical doctors as well as psychiatrists and mental health support. This is ideal in that a more integrative team oversees the patients, and allow for communication between clinicians of varying expertise. 

In this chart by Leatt, Pink & Gurriere (2000), having an integrated care setting can help providers with communication in clinical data. If care were to be separated, that communication can be almost inexistent, leading to fragmentation of healthcare practitioners and systems.

Many chronic conditions may be comorbid in any given patient. As health problems rise with age, seniors are more likely to report chronic conditions and accompanying poor health. Following a Canadian Statistic in 2009, 25% of seniors reported at least four chronic conditions, compared with 6% of adults aged 45 to 64 (Statistics Canada, 2018). In 2005, the World Health Organization proposed that there can be “no health without mental health.” (Conventry et al., 2015). By having focuses and specialties separated, will there be likely lacking communication between clinicians, leading to lessened collaboration, and may result in affecting the health of the patient.

Integrated Mental Healthcare Sub-Post #1: Moral Distress

In our Ethics and Bioethics of Aging and Health course, we talk about moral distress. There is distress between the different hierarchy of practitioners where one may feel hopeless in communicating certain aspects of patient care to the higher up.

A multidisciplinary healthcare team has been shown to help mitigate moral distress. By building proper support networks, we can find colleagues who can support ourselves and each other to address moral distress (Epstein, 2010). We can further avoid fragmenting the health team by ensuring that proper collaboration and communication is emphasized in the integrative model of health care.


Baylor S. & White Health. (2013). Mental Health and Aging. Retrieved from: https://www.youtube.com/watch?v=5MvbsegvUhU

Conventry, P. et al. (2015). Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ, 350 doi: https://doi.org/10.1136/bmj.h638

Epstein, E. & Delgado, S. (2010). "Understanding and Addressing Moral Distress" OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 3, Manuscript 1. DOI: 10.3912/OJIN.Vol15No03Man01

Horgan, S. (2019). Lecture slides.

Leatt, P., Pink, G. & Guerriere, M. (2000). Towards a Canadian Model of Integrated Healthcare. HealthcarePapers 1(2): 13-35.doi:10.12927/hcpap..17216

Petersen, I. (2000). Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility? Social Science & Medicine. 51(3): 321-334.

Statistics Canada. (2018). Seniors. Retrieved from: https://www150.statcan.gc.ca/n1/pub/11-402-x/2011000/chap/seniors-aines/seniors-aines-eng.htm

World Health Organization. (2019). What is Healthy Ageing?. Retrieved from: https://www.who.int/ageing/healthy-ageing/en/


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