There is a large effort to integrate psychiatric care into primary-care practices, in the hope of making better use of a limited number of mental-health professionals. Providers are expecting a surge of new patients seeking mental-health care under the federal health law.

Beginning next week, plans sold on the new insurance exchanges must provide at least some mental-health coverage. Existing plans must provide some when they come up for renewal.

The concept of having primary-care providers treat mental-health issues with psychiatrists’ oversight isn’t new but is catching on everywhere, including large health systems like Kaiser Permanente, and pilot Medicaid and Medicare projects.

Growing awareness that medical and mental-health problems are often linked is also prompting awareness. Patients with diabetes and heart disease have twice the rate of anxiety and depression as the general population. Typically, busy primary-care doctors hand such patients a referral to a mental-health specialist, but only 60% of patients follow through, according to a University of Washington study. In an integrated-care practice, doctors can do a “warm handoff” instead, introducing patients to a counselor on site. “It’s so important to capture that moment,” says internist Thomas Goforth, medical director of the Family Health Center of Harlem. “If a patient gets comfortable with a counselor before ever leaving the building, he’s much more likely to return.”

In some practices, psychiatrists and psychologists work with primary-care providers. In others, primary-care doctors prescribe antidepressants or other medications, and care managers –  often licensed clinical social workers monitor patient progress.

Studies have shown that integrated-care can reduce patients’ depression and cut costs. One study found that providing a year of integrated care cost $600 a patient but saved an average of $4,000 in lower medical bills over the next four years. Yet, integrated care can be a hard sell in cities where there are a lot of psychiatrists, and patients can pay for traditional therapy. The American Psychiatric Association, the American Psychological Association and the American Academy of Family Physicians have all endorsed the concept. Many patients also like the approach. One woman who gets treated for schizophrenia, bipolar disease and diabetes at the Family Health Center of Harlem says, “They are helping me keep everything in balance.”          wsj.com 9/24/13

 

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