What is Integrated Mental Health Care?Evidence-based collaborative care programs are patient-centered and provide integrated care for medical and mental health needs in primary care and other clinical settings. Over 30 studies have found such programs to be more effective than usual care for common mental disorders such as depression and anxiety.
Offering mental health treatments in primary care is convenient for patients, can reduce the stigma associated with treatment for mental disorders, builds on existing provider-patient relationships, and can help improve care for the millions of patients who have both medical and mental disorders. Such integrated care has also shown to be more cost-effective than care as usual.
One example of such an evidence-based collaborative care program is the IMPACT model.
Effective collaborative care programs go beyond ‘co-locating’ a mental health professional in a primary care clinic. They use established principles of chronic illness care and collaborative care teams in which professionals with complementary skills work closely together to care for a population of patients with mental problems such as depression or anxiety disorders. Clinic staff trained as care managers work closely with the patient’s primary care provider to help engage and support patients in treatment, track clinical improvement over time and support medication management by primary care providers. They also offer brief counseling (using evidence-based techniques such as motivational interviewing, behavioral activation, and problem solving) and help facilitate changes in treatment if patients are not improving as expected.
Care management registries and clinical rating scales identify patients who are at risk of ‘falling through the cracks’ and support measurement-based stepped care in which treatment is systematically intensified or changed if patients are not improving.
Designated psychiatric consultants provide training in evidence-based mental health care to help improve the capacity of primary care-based teams, oversee a caseload of patients with mental disorders followed in primary care, and consult to primary care providers on patients who are clinically challenging or who need specialty mental health services.
The diagram below summarizes the Washington State Mental Health Integration Program (MHIP), one example of an evidence-based integrated care program.
The evidence for integrated mental health care is now so extensive that researchers and policy-makers urge that efforts be shifted from studying the approach to helping healthcare organizations implement it.1 This is the mission of the AIMS Center.
1Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression:
a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006 Nov 27;166(21):2314-21.