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  • Dr. Romi Fung, ND

Integrated Mental Healthcare Post #6: Overall Health System Optimization

Updated: Dec 7, 2019

In this series of posts on Integrated Mental Healthcare, we have seen how having an Integrated model can:


  1. Improve access to mental health care

  2. Provide patient-centred care

  3. Avoid fragmentation of health services

  4. Decrease stigma

  5. Optimize mental and physical health


In this final post, we will talk about how an integrated mental healthcare can optimize overall health systems.


Though it is clear that having an integrated primary care team can truly provide a holistic care for the patients and older adults, recent studies have associated integrated or collaborative approaches with increased detection, diagnosis and treatment of complex health issues, improved communication and coordination, and strengthened practitioner knowledge (Horgan, 2019). By having an integrative and collaborative team, consultation between specialties and focuses can be more accessible. One case study investigation showed improvement in communication between mental health and primary care providers (Wells et al., 2019). It's being able to communicate under the same setting that can optimize the level of care than say communication over different clinical buildings via e-communication. There's something about having a proper team dynamic and relationship through effective communication.


In another study, the researchers found that though the primary outcome of integrated care is perceived improvement of quality of life of the older adults, they've noted a secondary outcome. This secondary outcome is a perceived level of implementation of integrated elderly care (Uittenbroek, Kremer, Spoorenberg, Reijneveld & Wynia, 2017). The clinicians in the study "reported that the average “level of implementation of integrated elderly care” at baseline was “basic” and, after 12 months, “reasonably good,” indicating clinically relevant improvement" (Uittenbroek, Kremer, Spoorenberg, Reijneveld & Wynia, 2017). Based on the outcomes, there were increased levels of organization, decision, delivery of decision, information systems and integration, which truly means that there was more thorough communication between the general practitioners, elderly care physicians, nurses and social workers.




In a study by Baxter et al. (2018), they conclude that "models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services."


In other words, having a collaboration in an integrated healthcare setting can better optimize the health system. Patients are being more thoroughly screened on site and have better access to care, and clinicians and practitioners are able to involve themselves in understanding their scopes and referring for assessment when necessary. The bottom line is that patients and clinicians benefit this model. As shown in the first post, I take you back to this video again on the collaboration of healthcare and how integration can contribute to:

  1. Improve access to mental health care

  2. Provide patient-centred care

  3. Avoid fragmentation of health services

  4. Decrease stigma

  5. Optimize mental and physical health

  6. Overall Health System Optimization



Integrated Mental Healthcare Sub-Post #1: Medical Model of Mental Health and Illness





Though we talk about an integrated model, we must first look at the conventional medical model to mental health. The Medical Model assumes a direct connection between behaviour and thoughts and physical occurences within the brain (Horgan, 2019). Treatment then involves improving biochemical imbalances (Horgan, 2019).


An assessment may involves clinical interviews, observations, reviewing medical records and psychometric testing (Horgan, 2019). These assessments can easily be done in primary care settings, and easily referred for further assessment when the general practitioner requires so. Treatment will likely involve prescribing medications to optimize changes in the biochemical level.


In the Integrated healthcare setting, the medical model can apply more effectively when patients coming in aren't just being labeled depressed and prescribed medications accordingly. Through proper assessment of clinical interviews and observations, an older adult's mental health may actually stem from a physical concern, such as mobility or pain. By understanding the interconnectedness of the realms of health that can be addressed by an integrated model, can clinicians effectively treat patients and older adults with their mental health.





Integrated Mental Healthcare Sub-Post #2: Applying Policies Relevant to Mental Health


"The need to review the evidence related to specific models of integrated primary and mental health and substance use (MHSU) care in the community aligns with the Integrated Primary and Community Care initiative in B.C. to integrate family physicians, home and community care, and the mental health and substance use system with the focus on populations with complex health and mental health/substance use needs."





Based on the "Integrated models of primary care and mental health & substance use (MHSU) care in the community," British Columbia strives to realize that both communication between practices and medically-provided MHSU care are examples of the traditional linkage between primary care and MHSU care (BC Ministry of Health, 2012). BC has expressed the need for integration of primary care and mental health and substance use care to further the level of care. This translates to more hopeful funding and research in the areas of dementia care, homelessness, and chronic disease management seeing that an overall health system optimization is likely needed via integration to be able to allow for accessibility in services.




References


Baxter, S., Johnson, M., Chambers, D., Sutton, A., Goyder, E., & Booth, A. (2018). The effects of integrated care: a systematic review of UK and international evidence. BMC health services research, 18(1), 350. doi:10.1186/s12913-018-3161-3

British Columbia Ministry of Health. (2012). Integrated models of primary care and mental health & substance use care in the community. Retrieved from: http://www.health.gov.bc.ca/library/publications/year/2012/integrated-models-lit-review.pdf


Horgan, S. (2019). Lecture Slides.


Uittenbroek, R. J., Kremer, H., Spoorenberg, S., Reijneveld, S. A., & Wynia, K. (2017). Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace. Journal of general internal medicine, 32(5), 516–523. doi:10.1007/s11606-016-3742-y

Wells R, Breckenridge ED, Ajaz S, Narayan A, Brossart D, Zahniser JH, et al.. (2019). Integrating Primary Care Into Community Mental Health Centres in Texas, USA: Results of a Case Study Investigation. International Journal of Integrated Care. 19(4):1. DOI: http://doi.org/10.5334/ijic.4630



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