Dear Patients, How to Engage in Integrated Care
9 Ways To Receive Better Mental Health Services in Primary Care
#1: Know if you need integrated care. Integrated care is when your mental and physical conditions are treated together in a coordinated fashion in one place, (e.g. primary care PC). If you are a patient of any age with both physical and mental or addiction issues, you should be receiving integrated care. Often older, sicker patients with ongoing conditions like diabetes, asthma, cancer who also have depression, anxiety, chronic pain, or substance use disorders, are candidates for these services.
#2: PC clinics are finding it difficult to give effective integrated care services since it is a developing area of medicine. Also, primary care clinics vary widely in their general characteristics such as finances, staffing, clinic workflow, culture, insurance accepted. Plus they vary in their ability or willingness to provide integrated care services. Many practices, including those with deep resources and experience, find integration challenging.
#3: Things to look for: If you are a patient with medical and mental health needs, things to look for whether your primary care clinic is offering high-quality integrated care:
- a) clinic routinely identifies patients with mild/moderate mental health or substance abuse issues who need help
- b) once identified, patient receives an assessment of their conditions and a care plan to treat both conditions
- c) care team routinely measure and monitor your symptoms and adjust treatment or medications when needed
- d) clinic care-teams made up of medical and mental health professionals are trained specifically in how to deliver effective integrated care
- e) clinic has solid relationships with outside medical and mental health professionals with whom they can consult and refer patients if needed
- f) clinic has cooperative relationships with community-based entities able to assist patients with social issues, e.g. food, housing, transportation etc
#4: Play your central role. As patient, you are an essential member of the care-team. Integrated care services will not be effective unless patients play their central role. Tell your doctor all your health needs, physical and mental, and social stressor issues. Be as frank and forthright as possible. Expect to complete periodic patients surveys and questionnaires since this is how care team collects patient-centered data on results and find out what’s working and not.
#5: Measurement and team care essential. Consistently measuring and monitoring your medical and mental health/substance symptoms prevents patients from ‘falling through the cracks’ and not improving or recovering. The care-team wraps services around you, the patient. The days of only 1on1 care between medical doctor and patient, are mostly passing. There is now so much to be done in primary care that it takes a team to do it comprehensively, thoroughly and in a coordinated fashion and collect data showing the results and value of this innovation. Effective team care also builds and supports relationships and the trust that underlies good healthcare services and patient engagement.
#6: Practice leadership counts. Look for signs the leaders of the practice or health systems make a priority of, and take pride in, offering effective integrated care. Integrated care is challenging because it requires the care team learning new habits, new skills and approaches to care. Are their clear signs that practice leadership fully embrace this way of providing their patients’ healthcare, such as certificates on display showing care team training in integrated care, patient handouts explaining how integrated services work in their practice.
#7: How it’s done may vary. Integration may involve onsite mental health professionals working in clinic alongside your medical doctor and/or may involve an offsite psychiatrist that you may only see once reviewing your record and offering advice and recommendations to your doctor on your mental health care. Either way, your primary care physician remains the quarterback of all your care. This is ideal since this is a trusted confidential relationship with knowledge of your entire health history.
#8: Stay engaged with care team. Especially as they try to work through all your medical and behavioral health issues over a period of time. Remember: behavioral health is a new world for primary care.
#9: Make a move towards high-performing clinics offering integrated care, if necessary! If your primary care doctor doesn’t take time to listen, ask questions and show interest in BOTH your physical and mental health issues, consider finding another high-quality primary care practice open to practicing integrative medicine.
To Go Deeper: For more detail read: “Integrating Mental Health Services in Primary Care From the Patient’s Perspective” at www.nhmh.org.