The Substance Abuse and Mental Health Services Administration (SAMHSA) describes the vital importance of integrating behavioral health with primary care in this way:
“People with mental and substance abuse disorders may die decades earlier than the average person – mostly from untreated and preventable chronic illnesses like hypertension, diabetes, obesity, and cardiovascular disease that are aggravated by poor health habits such as inadequate physical activity, poor nutrition, smoking, and substance abuse. Barriers to primary care – coupled with challenges in navigating complex health care systems – have been a major obstacle to care. At the same time, primary care settings have become the gateway to the behavioral health system, and primary care providers need support and resources to screen and treat individuals with behavioral and general health care needs. The solution lies in integrated care, the systematic coordination of general and behavioral health care. Integrating mental health, substance abuse, and primary care services produces the best outcomes and proves the most effective approach to caring for people with multiple health care needs.”
The federal Agency for Healthcare Research and Quality (AHRQ) defines integrated behavioral health care as:
“The care a patient experiences as a result of a team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization.”
Over the past decade, the concept of integrated behavioral health (IBH) has emerged as a prominent issue in national health reform efforts. Primary care providers in Montana and across the U.S. are discovering integration as a means to better care for a range of chronic and acute health conditions. Furthermore, innovative models being implemented nationwide are using integration as the bedrock of larger health system changes designed to better serve all clients with complex health care needs, including those with severe and disabling mental illness and substance use disorders.
In our 2015 grants, we made investments in agencies and communities to integrate behavioral health into primary care. We are expanding on this work in 2016, through grants under our new Integrated Behavioral Health Initiative.
We are also collaborating with the state health department to support IBH at the state level. The Montana Department of Public Health and Human Services (DPHHS), Children’s Mental Health Bureau received a three-year SAMHSA grant that started in October 2015. The grant will focus on the health care needs of 16-25 year olds with mental illness and substance use disorders. The implementation of the grant will be a collaborative effort with the Addictive and Mental Health Disorders Division as it spans youth and adult mental health and substance abuse disorder services. To support this work, we are collaborating with DPHHS to engage the National Council for Mental Wellbeing to assist with training and consultation activities for this grant. This collaboration may ultimately also result in policy changes that offer better support for IBH – such as a Medicaid state plan amendment to create a “behavioral health home” program.
