Presents the justification and advantages of providing mental health services in primary care. Provides advice on how to implement and scale-up primary care for mental health, and describes how a range of health systems have successfully undertaken this transformation. Part 1 provides the context for understanding primary care for mental health within the broader health care system. Part 2 explains how to successfully integrate mental health into primary care and highlights 10 common principles which are central to this effort. It also presents 12 detailed case examples to illustrate how a range of health systems have undertaken this transformation. Annex 1 provides information about the skills and competencies that are required to effectively assess, diagnose, treat, support and refer people with mental disorders.
Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge baseâ€"as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers: The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systemsâ€"important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.
Integrated care incorporates behavioral and physical health services into primary care and specialty medical environments. These models of care are patient-centered. population focused, and delivered by a multidisciplinary team of medical professionals. This book is practical, office-based, comfortably accessible, and intended for mental health professionals, primary care and medical specialists, and professional health students, residents, and other professionals working in integrated care environments.
The goals of Integrated Care: Working at the Interface of Primary Care and Behavioral Health are to educate psychiatrists about the fundamental shift underway in health care and to prepare them to be successful and effective in the new health care arena. The passage and implementation of the Patient Protection and Affordable Care Act presents an opportunity for newly insured patients and for funding models of integrated care, enabling psychiatrists to have a more significant population-level impact. The only book of its kind, the guide defines integrated care, reviews the evidence base, and addresses the three potential benefits of this model of care: improved outcomes, cost containment, and enhanced patient experience (also known as the "triple aim"). The new models of integrated care presented in this book are population-based, which is the key to improved outcomes, and they represent a change in how medicine in general and psychiatry in particular will approach health care delivery moving forward. The book's features are both high-impact and user-friendly: The book is divided into two sections, "Behavioral Health in Primary Care Settings" and "Primary Care in Behavioral Health Care Settings," with Section 1 focused on improving the detection and treatment of behavioral health conditions by integrating behavioral health services into primary care settings and Section 2 focused on improving the health status of patient populations with serious mental illness by integrating primary care into behavioral health treatment. Each chapter presents a set of "core principles of effective collaborative care," which serve as a guide for the structure and provision of care for the varying models, regardless of the setting. Contributors provide dozens of examples that highlight the impact psychiatrists can make in achieving the triple aim of improved outcomes, cost containment, and enhanced experience. Detailed case vignettes integrated throughout the book bring concepts to life and help clinicians to understand and improve the patient-provider relationship. The information presented in these chapters allows both practicing psychiatrists and those in training to develop a skill set essential to designing, working in, teaching, or promoting an integrated care program within a health care system. Evidence based and timely, Integrated Care: Working at the Interface of Primary Care and Behavioral Health is a must read for clinicians in the brave new world of health care reform.
Integrated Care: A Guide for Effective Implementation provides a detailed, thoughtful, and experience-based guide to the complex and potentially overwhelming process of implementing an integrated care program. The advantages of integrated care from both the clinical and administrative perspectives are many, including better detection of illness, improvement in overall health outcomes, a better patient care experience, flexibility in responding to policy and financial changes, and an emphasis on return on investment. The book addresses the emerging framework of core principles for effective integrated care, reviews the most up-to-date research on implementation, and presents practice-based experience to serve as a guide. This information is useful in both traditional integration of behavioral health into general medical settings (often primary care) or integrating general medical care into a specialty mental health or substance use treatment setting. Because administrators, clinicians, policy makers, payers and others need guidance in determining what effective implementation looks like, the authors offer a three-part examination of the key components of an implementation strategy and explore the elements essential for success. The book is grounded in the authors' real-world expertise and offers readers practical, accessible information and support: Often efforts to implement an integrated care program fail because the model is more than just "plug and play." To address this misconception, the authors explore the successful implementation from every angle -- from leadership, primary care, therapist, psychiatric provider, and policy perspectives. As procedural and institutional hurdles are being overcome, codes for integrated care have been adopted. Accordingly, the book provides in-depth coverage of finance and funding models, challenges to billing, and emerging payment models. Each of the chapter authors were selected for their direct clinical experience in various integrated environments, their leadership in ushering teams through these initiatives, and/or their deep knowledge of payment and policy barriers. Impediments to the widespread implementation of evidence-based programs include payment and regulatory barriers, lack of a workforce trained in effective collaboration, and cultural differences between the worlds of primary care and behavioral health care. Integrated Care: A Guide for Effective Implementation helps health care leaders and providers overcome these obstacles to implement a successful, patient-centered integrated care program.
Behavioral health conditions, which include mental health and substance use disorders, affect approximately 20 percent of Americans. Of those with a substance use disorder, approximately 60 percent also have a mental health disorder. As many as 80 percent of patients with behavioral health conditions seek treatment in emergency rooms and primary care clinics, and between 60 and 70 percent of them are discharged without receiving behavioral health care services. More than two-thirds of primary care providers report that they are unable to connect patients with behavioral health providers because of a shortage of mental health providers and health insurance barriers. Part of the explanation for the lack of access to care lies in a historical legacy of discrimination and stigma that makes people reluctant to seek help and also led to segregated and inhumane services for those facing mental health and substance use disorders. In an effort to understanding the challenges and opportunities of providing essential components of care for people with mental health and substance use disorders in primary care settings, the National Academies of Sciences, Engineering, and Medicine's Forum on Mental Health and Substance Use Disorders convened three webinars held on June 3, July 29, and August 26, 2020. The webinars addressed efforts to define essential components of care for people with mental health and substance use disorders in the primary care setting for depression, alcohol use disorders, and opioid use disorders; opportunities to build the health care workforce and delivery models that incorporate those essential components of care; and financial incentives and payment structures to support the implementation of those care models, including value-based payment strategies and practice-level incentives. This publication summarizes the presentations and discussion of the webinars.
Research has shown that a range of adult psychiatric disorders and mental health problems originate at an early age, yet the psychiatric symptoms of an increasing number of children and adolescents are going unrecognized and untreated—there are simply not enough child psychiatric providers to meet this steadily rising demand. It is vital that advanced practice registered nurses (APRNs) and primary care practitioners take active roles in assessing behavioral health presentations and work collaboratively with families and other healthcare professionals to ensure that all children and adolescents receive appropriate treatment. Child and Adolescent Behavioral Health helps APRNs address the mental health needs of this vulnerable population, providing practical guidance on assessment guidelines, intervention and treatment strategies, indications for consultation, collaboration, referral, and more. Now in its second edition, this comprehensive and timely resource has been fully updated to include DSM-5 criteria and the latest guidance on assessing, diagnosing, and treating the most common behavioral health issues facing young people. New and expanded chapters cover topics including eating disorders, bullying and victimization, LGBTQ identity issues, and conducting research with high-risk children and adolescents. Edited and written by a team of accomplished child psychiatric and primary care practitioners, this authoritative volume: Provides state-of-the-art knowledge about specific psychiatric and behavioral health issues in multiple care settings Reviews the clinical manifestation and etiology of behavioral disorders, risk and management issues, and implications for practice, research, and education Offers approaches for interviewing children and adolescents, and strategies for integrating physical and psychiatric screening Discusses special topics such as legal and ethical issues, cultural influences, the needs of immigrant children, and child and adolescent mental health policy Features a new companion website containing clinical case studies to apply concepts from the chapters Designed to specifically address the issues faced by APRNs, Child and Adolescent Behavioral Health is essential reading for nurse practitioners and clinical nurse specialists, particularly those working in family, pediatric, community health, psychiatric, and mental health settings. *Second Place in the Child Health Category, 2021 American Journal of Nursing Book of the Year Awards*
Over the course of the last decade, political and mental entities at large have embraced global mental health: the idea that psychiatric health is vital to improved quality of life. Physicians globally have implemented guidelines recommended by the National Institute of Mental Health (NIMH) in 2007, thereby breaking down barriers to care and improving quality of life in areas where these practices have been implemented. Programs for training and education have expanded as a result. Clinicians benefit more from both local resources in some regions as well as in international collaboration and technological advancements. Even amidst all of these positive outcomes, clinicians still face some stumbling blocks. With worldwide statistics estimating that 450 million people struggle with mental, neuropsychiatric, and neurological disorders—25 percent of the world’s non-communicable disease burden—rising to these challenges prove to be no small feat, even in wealthy Western nations. Various articles and books have been published on global mental health, but few of them thoroughly cover the clinical, research, innovative, and social implications as they pertain to psychiatry; often, only one of these aspects is covered. A comprehensive text that can keep pace with the rapidly evolving literature grows more and more valuable each day as clinicians struggle to piece together the changes around the world that leave open the possibility for improved outcomes in care. This book seeks to boldly rectify this situation by identifying innovative models of service delivery, training, education, research funding, and payment systems that have proven to be exemplary in implementation and scalability or have potential for scalability. Chapters describe specific barriers and challenges, illuminating effective strategies for improved outcomes. This text is the first peer-reviewed resource to gather prestigious physicians in global mental health from around the world and disseminate their expertise in the medical community at large in a format that is updateable, making it a truly cutting-edge resource in a world constantly changed by medical, scientific, and technological advances. Innovations in Global Mental Health is the ultimate resource for psychiatrists, psychologists, primary care physicians, hospitalists, policy makers, and all medical professionals at the forefront of global mental health and its implications for the future.
Comprehensive, wise, and incredibly practical, this exciting volume walks through the joys and challenges of an entirely new vision of behavioral health consultation in primary care settings. Gently, and with good humor, the authors show how to avoid key errors, and provide a detailed, point by point guideline for success in an effective and needed new form of practice. You will forever think differently about the proper role of behavioral health providers in health care delivery. Even better, you will be prepared to do something about it. -- Steven C. Hayes, University of Nevada The Primary Care Behavioral Health (PCBH) model is fast emerging as the future of integration between mental health and primary care services. As the first book to detail the model, Behavioral Consultation and Primary Care: A Guide to Integrating Services explains in hands-on terms how to achieve truly integrated care. From starting up a new PCBH service to evaluating its outcome, clinicians and medical administrators alike will find much of value here. Written by two veteran Behavioral Health Consultants (BHCs), the Guide offers a wealth of practical advice for all levels of therapists entering primary care. Every detail of BHC work is discussed, ranging from key job competencies to proven strategies for navigating challenging new terrain. Detailed case examples also bring theory to life for a wide variety of common clinical problems. Real-world features designed to help establish a service and ease the transition from specialty mental health to primary care: -Specific administrative recommendations for setting up a BHC office, scheduling patients, billing, and staffing -Start-up checklist, chart note templates, handouts for generating referrals, and other valuable tools -Chapters outlining the therapeutic approaches and assessment methods best suited to BHC work -Creative strategies for influencing that new colleague--the primary care provider-Case examples to illustrate typical consultations with children, adults, and older adults, as well as innovative group approaches -Tips for handling ethical concerns unique to the PCBH model, and professional and personal challenges unique to the primary care setting The authors’ lively and engaging style is accessible to a wide range of professionals, so seasoned practitioners and neophytes--as well as the administrators who hire them--will find this material totally accessible. In addition to assisting professionals in the field, the Guide is perfectly suited for use in a variety of graduate classes and residency training programs.
