BEHAVIORAL HEALTH INTEGRATION
BEHAVIORAL HEALTH INTEGRATION
We Can Do Better .
By Dr . Jason Friday , MD
It has been 20 years now since the Institute of Medicine advocated for the bringing together of primary care and mental health services , a concept which has become commonly known as behavioral health integration . 1 Broadly speaking , behavioral health integration is the addressing of behavioral health disorders , both mental health and substance abuse disorders , within the primary care setting .
In this article , I will use the most common mental health disorder – depression – to illustrate why integrating behavioral health within primary care is important , along with key areas of consideration when it comes to screening , evaluating , and delivering care .
Depression
Depression ( i . e . major depressive disorder or clinical depression ) is one of the illnesses that behavioral health integration can significantly impact . The economic burden of depression in the U . S . is greater than $ 210 billion – and growing 2 . Moreover , a larger number of patients suffer from depression than from diabetes 3 , 4 ,. Despite this , the rates of diagnosis and treatment continue to be low 5 .
The large number of people that are not receiving treatment for their depression is shocking – and unacceptable . As health care providers , we must improve our efforts to actively address this epidemic .
Treatment of Depressive Symptoms By Severity
Severe
Moderately Severe
Moderate
Mild
None
49.15 % |
22.88 % |
14.41 % |
13.56 % |
60.25 % |
13.25 % |
12.30 % |
14.20 % |
63.75 % |
10.38 % |
9.97 % |
15.90 % |
77.33 % |
5.30 % 5.99 % 11.38 % |
90.47 % |
1.44 % 2.82 % 5.27 % |
0 % 20 % 40 % 60 % 80 % 100 % Neither Therapy Both Therapies Psychotherapy only Pharmacotherapy only
1 Donaldson , et al . Primary Care : America ’ s Health in a New Era . Washington , DC : National Academy Press . 1996 . doi : 10.17226 / 5152 .
2 Greenberg , et al . The Economic Burden of Adults with Major Depressive Disorder in the United States ( 2005 and 2010 ). Journal of Clinical Psychiatry . 2015 Feb ; 76 ( 2 ): 155-162 . doi : 10.4088 / JCP . 14m09298 .
3 Pratt , L and Brody D . Depression in the U . S . Household Population , 2009 – 2012 . NCHS Data Brief No . 172 . 2014 Dec .
4 Diabetes : At A Glance 2016 . National Center for Chronic Disease Prevention and Health Promotion . 2016 Jul 25 .
5 Wittayanukorn , et al . Prevalence of Depressive Symptoms and Predictors of Treatment Among US Adults from 2005 to 2010 . General Hospital Psychiatry . 2014 May-Jun ; 36 ( 3 ): 330-336 . doi : 10.1016 / j . genhosppsych . 2013.12.009 .
TODAY ’ S PRACTICE : CHANGING THE BUSINESS OF MEDICINE 10