Behavioral health problems such as depression, anxiety, alcohol or substance abuse are among the most common and disabling health conditions worldwide. They often co-occur with chronic medical diseases and can substantially worsen associated health outcomes.1 When behavioral health problems are not effectively treated, they can impair self care and adherence to medical and mental health treatments and they are associated with increased mortality and increased overall health care costs.
Since the first research trials in the 1990’s investigating the integration of mental health treatment into primary care, dozens of published studies have demonstrated the effectiveness of collaborative care for common mental disorders.2,3 As research evidence supporting the integration of mental health care into primary care mounts, concomitant interest in the dissemination of these evidence-based models grows among payers, policy makers, healthcare providers and healthcare consumers.
The Institute of Medicine (IOM) Crossing the Quality Chasm Report has shown, however, that once improved quality of care programs are developed, organizational and other system level barriers have to be overcome for effective dissemination to occur.4 These barriers include: limited consumer, employer, and purchaser demand for evidence-based integrated care models, disparities in funding between medical and mental disorders, poor alignment of financial and clinical incentives to coordinate and improve quality of care for depression and other common mental disorders, and existing performance criteria that have not been shown to be associated with improved outcomes.5 Other barriers can include competing quality improvement initiatives for other chronic medical disorders, such as diabetes or congestive heart failure.
Interest in the Patient-Centered Medical Home (PCMH) and Accountable Care Organizations (ACO) presents a timely opportunity to accelerate the implementation of evidence-based integrated mental health services for common mental disorders in primary care. A recent report published by the Agency for Healthcare Research and Quality recognizes this opportunity and outlines “five essential measures…that collectively will facilitate integrated mental health treatment in primary care settings and that are needed for the PCMH to achieve its full potential”.6 One of these measures is creation of a roadmap for implementation and performance assessment.
The AIMS Center will host an invitation-only summit meeting (Integrated Mental Health Summit) to bring together thought leaders and experts from public and private sector health plans and health care organizations and researchers studying evidence-based integrated mental health programs. The purpose of this meeting is to examine the state of the art of integrated mental health care, review successful dissemination and implementation efforts, discuss opportunities to advance evidence-based integrated care programs in the context of the patient-centered medical home and to develop work groups that will collaborate to promote widespread implementation of integrated mental health care.
Work groups focused on topics relevant to integrated mental health care (e.g. training and workforce development, health information technology, health disparities, health services and implementation research) will be formed during the summit meeting and will continue to work together for one year following the summit. The purpose of the work groups is to develop a detailed plan to translate existing knowledge about integrated mental health into action and to identify and pursue the most promising opportunities for such translation.
1Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007;370(9590):851-8.
2Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and Organizational Interventions to Improve the Management of Depression in Primary Care: A Systematic Review. JAMA. 2003;289(23):3145-51.
3Neumeyer-Gromen A, Lampert T, Stark K, Kallischnigg G. Disease management programs for depression: a systematic review and meta-analysis of randomized controlled trials. Med Care. 2004;42(12):1211-21.
4Committee on Quality of Health Care in America. Institute of Medicine: Crossing the quality chasm. Washington, D.C.: National Academy Press; 2001.
5Katon WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry. 2003;54(3):216-26.
6Croghan T, Brown J. Integrating Mental Health Treatment Into the Patient Centered Medical Home. (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO2.) Rockville, MD: Agency for Healthcare Research and Quality.; 2010 Contract No.: Document Number|.