Integration of Psych Mental Health Care in the Primary Care Setting

The need for psychiatric care in the primary care setting is clearly the vision of the future in providing cutting edge care to patients. Approximately 44 million Americans, 26% of the population, experience mental health problems in any given year WHO (2004). According to the Surgeon Generals Report (2001) approximately 5%-7% of adults have a serious mental illness and about 5-9% of children have serious emotional disturbance. In the United States, the annual economic, indirect cost of mental illnesses is estimated to be $79 billion. Approximately $63 billion of that amount reflects the loss of productivity as a result of illnesses. But indirect costs also include approximately $12 billion in lost productivity resulting from premature death and almost $4 billion in lost productivity for incarcerated individuals and those who provide family care. Data has shown that a majority of Americans receiving treatment for behavioral health conditions receive it from a primary care physician. Many behavioral health conditions may be discovered by a primary care physician, even though the original intent of the visit was for a physical ailment. Several factors that contribute to "psychosocial-related medical utilization" include mental health and substance abuse disorders, stress, lack of coping skills and other psychological and social conditions. Notably several challenges are associated with the integration of mental health services in the primary care setting, especially in the arena of reimbursement for services. These are challenges that policy makers must consider in the context of the current health care reform. This presentation introduces a model for practice in place for 8 months integrating psychiatric mental health care in the primary care setting. Issues related to collaboration, billing, use of graduate FNP and PMHNP students are discussed. The goal in the continued development of this practice model is to refine the collaborative efforts so that the engaged parties and primary stakeholders will continue to work through issues as they arise and collaborate to develop solutions rather than pull the plug on this cutting edge initiative. This model represents the vision of the future for best practice standards for both psychiatric care and primary care.