Integrated Care: The Future of Behavioral Health

“I’ve been on the low

I been taking my time

I feel like I’m out of my mind

It feel like my life ain’t mine

I don’t wanna be alive

I don’t wanna be alive

I just wanna die today”

– Logic (1-800-273-8255) ft. Alessia Cara, Khalid^[1]ThatWallflowerJen. “35 Best Hit Songs About Anxiety, Depression, and Other Mental Illnesses.” Spinditty. 35 Best Hit Songs About Anxiety, Depression, and Other Mental Illnesses

The song that is quoted above was one of the biggest singles of 2017 and 2018. Why? What is the significance of a song that seems to be titled after a phone number? Well, 1-800-273-8255 is the number of the National Suicide Prevention Lifeline in the United States. As for its popularity, it is music that spoke and related to the people.

2017 saw the death of stars such as Chester Bennington, Chris Cornell, Hannah Stone, Dr. Dean Lorich and many more by suicide. 2018 saw the death of stars such as Anthony Bourdain, Avicii, Kate Spade, Verne Troyer, Mark Salling and others, also by suicide.

During the same time, stars such as Prince Harry, Chrissy Teigen, Lili Reinhart, WWE superstar Paige, Dwayne “The Rock” Johnson, Lady Gaga, Selena Gomez and many other high-profile stars also revealed their own battles with mental illness.

Celebrities are usually held up as the example of what we should aspire towards. The life of glamour, fame, money and luxury is something that a lot of people want and something that they think would bring them happiness. But as we see above, even they are dealing with their own battles with mental illness.

Thankfully, they have the resources necessary to get help with their mental health. Unfortunately, the same cannot be said about most Americans who are dealing with mental health issues

In 2017, 47,173 Americans died by suicide. In the same year, 1.4 million attempts were made at committing suicide. It has been estimated that every day, 129 people are committing suicide.^[2]“Suicide Statistics.” AFSP. https://afsp.org/about-suicide/suicide-statistics/. According to the National Institute of Mental Health(NIMH)^[3]“Major Depression.” National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/major-depression.shtml., in 2017, 17.3 million American adults suffered at least one major depressive episode.

These are startling and shocking statistics. Why are things this way, why are these people not getting the help they need? As discussed in the previous blog, “Troubles with Getting Mental Health Help and Insurance“, finding behavioral health support in the United States is hard.

It is either too expensive, or it’s too hard to find an appointment, or due to the stigma, the person suffering from the illness is ashamed of admitting that they need help.

In the case of the latter, according to Mental Health America^[4]“The State of Mental Health in America.” Mental Health America. http://www.mentalhealthamerica.net/issues/state-mental-health-america., 1 in 5 Americans report an unmet behavioral health need. In fact, a journal from the Cambridge University Press^[5]“What Is the Impact of Mental Health-related Stigma on Help-seeking? A Systematic Review of Quantitative and Qualitative Studies | Psychological Medicine.” Cambridge Core. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies , which reviewed 144 studies, over a 31 year span and included 90,189 combined participants, stigma does have an effect on the choice to get behavioral health help.

How do you change this situation? Things can’t be left as they are, there are too many people suffering and in need of help.  

The healthcare industry needs to change. The way that care is provided needs to change.

If you had a broken hand, you wouldn’t feel ashamed about going to the doctor and getting it treated. If you have a decent insurance plan, if you go to the doctor to get a flu shot, it would be covered by the insurance. With the same insurance plan, if you tried to find a primary care physician, you would have a lot of choices and wouldn’t have a hard time finding an appointment. Why?

Because those are considered to be “normal” things to do. Treating the body, preemptively and/or while ill, is something that society considers to be normal. We need to get this same mindset instilled when it comes to treating the mind. Because if you don’t treat it, it will lead to problems, including physical ones. It has been confirmed by the American Psychological Association(APA)^[6]“How Integrated Health Care Benefits You as You Get Older.” Psychology Benefits Society. How Integrated Health Care Benefits You as You Get Older that there is a significant correlation between mental and physical health. For example, the APA study cited above determined that there is a massive link, particularly in older populations, between untreated depression and the acceleration of heart disease.

There are several things that can be done and there are several ways to change the current system. One way to change it is by integrating behavioral health care with regular, primary care. So, instead of a person with mental illness having to struggle with finding a behavioral health care provider and dealing with any stigma associated with it, they would be able to go to their primary care providers office and get mental health help, without the stigma and without the struggle of trying to find a provider.

This hypothesis is not just baseless conjecture, it has been studied and researched multiple times. A 2017 study determined that integrated care significantly improved the quality of life for patients with chronic conditions, noting that “multi-component, condition-specific interventions were more likely to lead to positive patient outcomes.”^[7]“The Effectiveness of Integrated Care Interventions in Improving Patient Quality of Life (QoL) for Patients with Chronic Conditions. An Overview of the Systematic Review Evidence.” Health and Quality of Life Outcomes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5622519/

While care is the number one priority, practices also have to worry about finances and switching to an integrated care system might seem like an expensive and complicated procedure. But, it is not and in the long term, it is one that will pay off. As discussed in the previous blog, having an EHR would be a boon to a behavioral health provider, since it would allow them to file insurance claims easily, thus allowing them to accept more patients and increase their profit.

One of the reasons that most behavioral health providers shy away from hiring help to file insurance claims or use an EHR to do it, is because they want to keep overhead costs down. They have to do this, because they don’t have enough income coming in to make the cost justifiable. But the reason they don’t have enough income coming in, is because they don’t accept insurance, so those in need of behavioral health help don’t tend to go to them.

It is a cycle that can be broken by integrated care. Most primary care practices use an EHR system. Combining these two health providers under one practice, and using an integrated care EHR, would give behavioral health providers a system that will help alleviate the troubles they are having, it would increase revenue and would give more people access to behavioral health treatment.

We are living through turbulent times. As seen from the sobering statistics present in this blog and the previous blog, there are a lot of people out there who are reaching out for and/or are in desperate need of behavioral health treatment. Integrated care is a great decision that would help and benefit everyone involved in the care ecosystem.