Why is Integrated Health Care important?

Co-occurrence of chronic medical disorders and complex health needs are an expectation, not an exception for the severe and persistent mental illness (SPMI) population.

Mental illnesses are among the world’s most costly and burdensome conditions. Florida lags behind the nation in services, training and research funding in mental health.

  • Mental illness is a leading cause of disability in the U.S. for ages 15-44. By 2020, major depressive illness is expected to be the leading cause of disability in the world for women and children.
  • Behavioral health conditions commonly co-occur with other chronic health conditions in adults but services are rarely coordinated. The shortage of both behavioral health and primary care providers in many areas makes the provision of care, particularly integrated services, difficult.
  • Behavioral health conditions commonly co-occur with other chronic health conditions in adults and yet services are rarely delivered in coordination. 
  • Florida is the 3rd largest state, but it ranks 50th in the nation in per capita mental health spending.
  • People with serious mental illness die 25 years earlier from common medical conditions such as cancer and heart disease, making this among the most glaring health disparities in our nation.
  • Americans with severe mental illness spend 2 to 3 times more on healthcare than other patients, often due to late diagnosis and delayed treatment.
  • In spite of effective prevention, treatment and recovery, behavioral health conditions are under-diagnosed and under-treated in the U.S.
  • On average, 45% of suicide victims had contact with primary care providers within 1 month of suicide, and 75% of suicide victims had contact with primary care providers within the preceding year.

 Mortality Crisis

  • US Life Expectancy 2008 = 78 years
  • Seriously Mentally Ill = 53 – 57 years
    • Comparable to Cameroon, Gabon, Democratic Republic of Congo
  • Biggest Lifespan Disparity in U.S.:
    • 21-25 Years 

Massachusetts Department of Mental Health, 6/09

  High Rates of Chronic Illness

  • 70% of SPMI Population Has a Chronic Health Condition
    • Mostly Pulmonary Disease/Lung Cancer/Diabetes
  • 50% Have Two or More Chronic Conditions
  • 42% Have Conditions Severe Enough to Limit Function
  • Hep B Rates Increase 5x; Hep C 11x

National Association of State Mental Health Program Directors, 10/06

U.S. Health Delivery System

  • The dominant models of providing health care in the United States separate the mind and body
  • Separation has a negative impact on health care access, health care costs, and quality of care with a disproportionate share of the burden falling on women, the elderly, racial and ethnic minorities, and rural and immigrant populations

Health Care for the Whole Person Statement of Vision and Principles,
American Psychological Association

What are the Problems with the Traditional System

There are barriers to integrated care on multiple levels including clinical, financial, policy and organizational. These include:

  • Fragmentation of care; physical separation of providers
  • Separation of medical records; the left hand doesn’t know what the right hand is doing
  • Limited communication between medical and mental health providers
  • Primary care is often responding to multiple presenting problems creating time management issues
  • Primary care providers often have limited training in psychiatric disorders and their treatment; half of those with mental disorders go undiagnosed in primary care
  • Primary care patients often have limited access to specialty mental health providers

 Meland, Prime West Health System