Making Room for Mental Health in the Medical Home - Preventing Chronic Disease: November 2010: 09_0198

http://www.cdc.gov/pcd/issues/2010/nov/images/cover_nov10.jpg
November 2010
Volume 7: Issue 6
ISSN: 1545-1151
SPECIAL TOPIC
Making Room for Mental Health in the Medical Home
Michael F. Hogan, PhD; Lloyd I. Sederer, MD; Thomas E. Smith, MD; Ilana R. Nossel

Suggested citation for this article: Hogan MF, Sederer LI, Smith TE, Nossel IR. Making room for mental health in the medical home. Prev Chronic Dis 2010;7(6). http://www.cdc.gov/pcd/issues/2010/nov/09_0198.htm. Accessed [date].

PEER REVIEWED
Abstract

Discussions of health care reform emphasize the need for coordinated care, and evidence supports the effectiveness of medical home and integrated delivery system models. However, mental health often is left out of the discussion. Early intervention approaches for children and adolescents in primary care are important given the increased rates of detection of mental illness in youth. Most adults also receive treatment for mental illness from nonspecialists, underscoring the role for mental health in medical home models. Flexible models for coordinated care are needed for people with serious mental illness, who have high rates of comorbid medical problems. Programs implemented in the New York State public mental health system are examples of efforts to better coordinate medical and mental health services.


Introduction

Home is the place where, when you have to go there, they have to take you in.

Robert Frost, The Death of the Hired Man

The debate on health care reform is focused on expanding insurance coverage, but reform ultimately turns on improved care. An improved health care system must emphasize primary and preventive care, improving health through earlier and less costly care, while ensuring quality care when serious or complex illness emerges. Options to deliver integrated care include the medical home, large integrated care systems, such as the Mayo Clinic or Kaiser Permanente (1), and smaller integrated community health care systems (2-4). Each of these approaches focuses on planned, integrated, and coordinated medical services — largely provided by teams in primary care settings.

As this country considers its medical future, it is time to integrate mental health care with general medical care. We review key elements of medical home and coordinated care models and describe how these approaches enhance quality and outcomes for 1) children and adolescents, for whom early detection and treatment of mental illness is critical; 2) the general adult population, which receives the bulk of its mental health care in medical settings; and 3) people with serious mental illnesses, who increasingly receive both their mental and primary care in mental health settings.

full-text:
Preventing Chronic Disease: November 2010: 09_0198