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Implementing Integrated Primary and Mental Health Care Services
Fragmentation of primary care and mental health services pose substantial barriers to consumers in navigating and to providers in coordinating care across complex health care systems. Resulting from system fragmentation, several vulnerable populations are at risk for overuse, underuse, and misuse of health services. As an example, people living with serious mental illness (SMI) remain among the most medically vulnerable groups in the United States and experience many years of life lost compared to the general population resulting from untreated chronic care conditions that are aggravated by poor health habits and limited access to primary medical care. Similarly, individuals whose primary diagnosis is a medical or surgical often live with a co-occurring mental disorder, often depression or anxiety.
Improving the wellness of people with mental illness and co-occurring chronic conditions has become a national priority and is being addressed by promoting the integration and systematic coordination of physical and mental health services under the Affordable Care Act. Integrating these two systems of care can improve patient access, enhance communication between providers, and better accommodate patient choice and preference. While the benefits of providing care in integrated settings have become widely recognized, little is known about the development of these services, and the barriers and facilitating factors to their successful implementation.
This symposium focuses on the implementation of integrated primary and mental health and features four presentations that represent innovative approaches to implementing integrated care for underserved populations. Two symposium presentations describe the implementation of a policy experiment currently being conducted in Los Angeles County, where the Department of Mental Health (DMH) has funded 24 programs to integrate mental and physical health care. The first describes common implementation successes and challenges across programs, while the latter describes the implementation of peer health workers across all integrated programs. The third presentation describes consumer views and preferences for implementing a health care manager program in public mental health clinics under health care reform. The fourth presentation explores the implementation of mental health services into primary care setting serving Latino older adults in East Los Angeles. This presentation describes the process of implementing problem solving therapy to treat major depression into Program of All-inclusive Care for the Elderly from the perspectives of consumers and providers. The discussant is a senior expert on the topic of implementation research, and will draw together commonalities and differences between the four presentations, and will detail implications for future research.