Hospital and care system leaders are incorporating behavioral health services into an integrated system of care that guides and tracks patients over time. Incorporating behavioral health is critical to building a patient-centered approach that addresses all health-related needs.

Benefits of Incorporating Behavioral Health Care

One in four Americans experiences a behavioral illness or problem each year. "Behavioral" encompasses both mental illnesses and substance abuse disorders. Mental illnesses are specific, diagnosable disorders. Each disorder is characterized by intense alterations in thinking, mood and behavior. Substance abuse disorders result from the inappropriate use of alcohol, prescription drugs or illegal drugs.

Providers face many obstacles in caring for patients with behavioral health issues, including a fragmented care system and a lack of financial resources and support. There are fewer health care facilities and units dedicated to treating behavioral illnesses, and many behavioral health and physical health professionals work without a structured process of coordination.

Hospitals and care systems can follow an integrative and collaborative framework to incorporate high-quality, patient-centered behavioral health services and realize the many benefits of providing this care. These benefits include:

  • better patient outcomes and productivity;
  • improved access and reduced stigma;
  • cost savings and efficiency.

A framework that combines both integration and collaboration is key to successfully incorporating behavioral health in the care continuum:

Integration brings together inputs, delivery and management of services to provide diagnosis, treatment, care, rehabilitation and health promotion. Integration is structural, organizational and operational.

Collaboration is sharing planning, decision-making, problem-solving, goal-setting and other responsibilities. Health care professionals must work together cooperatively, communicating and coordinating openly. Collaboration is teamwork.

Integration in Health Care Settings

Integration plays a pivotal role in how patients access care, and it influences which health care professionals will provide care. There is no one-size-fits-all model for integration; models include a patient-centered medical home and an accountable care organization. Understanding how each model affects the delivery of behavioral health allows a health care leader to determine the requisite resources and training to deliver effective care. Even if a hospital or care system does not integrate behavioral health services, the organization must address how to provide these services if the community needs them, perhaps through collaboration.

Part of UnityPoint Health, the Robert Young Center for Community Mental Health is a community mental health center with a 25-bed adult psychiatric unit, six-bed child and adolescent unit, and 16-bed chemical dependency unit. With locations in Iowa and Illinois, it was the first CMHC in Illinois as well as the first hospital-based CMHC in Illinois or Iowa.

Working with the Iowa Health Physicians and a federally qualified health center, Robert Young Center embedded behavioral health specialists at five primary care locations. A specialist — typically a licensed clinical social worker or licensed clinical professional counselor — provides assessments, therapies and consultations for patients and their families. Behavioral health specialists and primary care physicians work together to create treatment plans, which provide holistic care to patients.

As integration of behavioral health services spread through its continuum of care, Robert Young Center saw significant results. In one quarter, the center had a 46 percent reduction in emergency room visits, 65 percent reduction in Medicaid payments for emergency department visits, and 50 percent reduction in psychiatric admissions, along with other significant positive health outcomes.

Greater Collaboration

With more integration in the care setting, greater collaboration is required to create a successful care model. In developing and cultivating collaboration, many actions are quick and easy to implement, such as organizing regular, frequent meetings between behavioral health specialists and other health care professionals. Some actions require a high degree of energy and organization, such as consistently deploying and using care managers throughout the care continuum. Even if a lower level of integration is chosen, hospital leaders still can implement new collaboration strategies.

With 47 clinical locations in 13 counties, the Tennessee-based Cherokee Health Systems serve more than 63,800 patients. Embracing a care delivery philosophy that treats the body and mind, Cherokee Health provides comprehensive primary care, quality behavioral health care and preventive care programs.

Cherokee Health Systems integrated behavioral health care into its care delivery system by co-locating, or embedding, behavioral health professionals such as psychiatrists and psychologists at the same care setting with physicians for real-time consultations. Behavioral health professionals now meet with physicians and care managers in person on a regular basis in the same setting. Care managers track high-need patients for treatment adherence. The collaboration between the care managers and medical professionals has led to significant positive outcomes.

Cherokee Health Systems has seen significant results: nearly a 20 percent increase in primary care visits for the overall patient population, 68 percent reduction in ED visits, 42 percent reduction in specialty care visits and 22 percent reduction in overall cost.

Support for Incorporating Behavioral Health

In most health care organizations, the delivery system for behavioral health services is fragmented and lacks a patient-centered approach. In addition, millions of Americans afflicted by behavioral illnesses have inadequate or no health insurance coverage, so they go without needed treatment or care. To meet the growing demand for behavioral health services, innovative providers are incorporating behavioral health into the continuum of care.

The American Hospital Association's Section for Psychiatric and Substance Abuse Services represents more than 1,600 behavioral health providers across a continuum of service levels, including general hospitals and freestanding specialty hospitals that provide any of the following services: psychiatric inpatient, outpatient, partial hospitalization, foster and/or home care; consultation and education; alcoholism/chemical dependency treatment — inpatient, outpatient or partial hospitalization; and clinical psychology.
This section is the heart of the AHA's behavioral health advocacy and policy initiatives and provides a forum to actively discuss critical behavioral health issues. Within this forum, the AHA facilitates introductions between behavioral health executives who want to share experiences and knowledge on particular issues. This AHA section also offers an array of member services — including executive small-group facilitated discussions on current best practices and research; monthly behavioral health updates on time-sensitive issues; and a members-only section website.

The AHA explored behavioral health in the TrendWatch article "Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes."

Using a framework characterized by integration and collaboration, providers can improve patient access to high-quality behavioral health care and create a holistic approach to care delivery. This type of coordinated care approach will allow providers to reduce the stigma attached to behavioral health, improve the physical health of the population and provide patient-centered care that will achieve the organization's mission and vision. The Institute of Medicine in 2006 summed up the importance of behavioral health: "Health care for general, mental and substance-use problems and illnesses must be delivered with an understanding of the inherent interactions between the mind/brain and the rest of the body."

Thomas Duffy is a program manager with the Health Research & Educational Trust, an AHA affiliate.