Integrated care for both mind and body under one roof? It may sound pie in the sky, but it’s really happening at an award-winning healthcare center in Anchorage, recently featured in Politico. How does it work? And can it be replicated?
A shining example in Anchorage
“It’s a truism that the mind and body are connected, but the U.S. health care system has long treated them as separate — with separate doctors, separate hospitals, separate payment systems,” Politico reports (detailing the history of these health care “silos”).
The Southcentral Foundation, which runs a healthcare center for native Alaskans in Anchorage, is in the spotlight for successfully bridging the mind/body divide.
“In part because of their Alaska Native heritage, which puts a high value on spiritual health, the leaders of Southcentral recognized decades ago that behavioral health is tightly linked with bodily health,” Politico says. “So they became one of the early adopters of integrated care.”
At Southcentral, checkups include a mental health evaluation, and a patient’s primary care team includes on-site psychologists or social workers.
For one patient, Vera, profiled in the Politico piece, “accessing mental health treatment was as easy as going to her regular doctor, and there was no stigma attached: Her mental health services were provided at the same time and in the same place as other medical care, just like heading down the hall for an X-ray or a blood test.” Vera was sexually abused as a child and later diagnosed with major depression. She experienced suicidal thoughts and may not be alive today without the integrated care she received at Southcentral, she says.
Advantages of integrated care
The World Health Organization (WHO) has recommended integrating mental health care into primary care for decades. Here are some of the benefits of integrated mental/physical health care that WHO outlined back in 2001:
- Less stigmatization of patients and staff, as mental and behavioral disorders are being seen and managed alongside physical health problems
- Improved screening and treatment, in particular improved detection rates for patients presenting with vague somatic (physical/bodily) complaints which are related to mental and behavioral disorders
- The potential for improved treatment of the physical problems of those suffering from mental illness, and vice versa
- Better treatment of mental aspects associated with “physical” problems
A popular notion — and the roadblocks
Research has shown that Americans value physical health and mental health equally. Also, “nearly half of Americans think they have or have ever had a mental health condition (47 percent), yet fewer than two in five have received treatment (38 percent),” according to a 2015 survey by the Anxiety and Depression Association of America.
In a 2017 PatientsLikeMe poll of more than 2,000 members, support for the Affordable Care Act (or “Obamacare”) is highly popular among those living with mental health conditions, perhaps because the policy’s “parity” requirement means that insurers have to cover mental and physical health issues equally.
Politico reports that there’s broad support for physical/mental (behavioral) health integration in both the healthcare sector and in Congress.
The Southcentral Foundation won the Malcolm Baldridge National Quality Award in both 2011 and 2017 for its innovative, top-quality care (psst: 97% patient satisfaction) at a relatively low cost. Douglas Eby, vice president of medical services at Southcentral, says he is often invited to speak at conferences in Washington, D.C., because the Southcentral model is “popular with the whole political spectrum.” (What? Whoa.)
So what are the biggest hangups? Money and stigma.
The U.S. health care and insurance system is structured in such a way that doctors are paid more for (physical) procedures, and they can actually lose money by integrating mental health. The longtime stigma of mental illness extends into the provider space, where mental health clinicians and services are valued much less, dollar-for-dollar, than their “physical care” counterparts.
“Solving these problems will take more than money; it will require changing the culture of medicine,” Politico concludes.
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