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 Mental and behavioral health issues like inappropriate eating
behaviors, sedentary lifestyle, and patterns of social isolation,
are common, and have been linked to increased physical illness,
higher mortality rates, poorer treatment outcomes and higher
healthcare costs, the ACP committee writes in the Annals of Internal
Medicine.
“The literature shows that most people with behavioral health needs
access the health care system through their primary care physician
or other health care professional,” said lead author of the
statement Ryan A. Crowley, senior health policy analyst for the ACP.
“Patients who exhibit physical ailments - such as chronic diseases
like diabetes - often have behavioral health problems that may
affect their physical care needs,” Crowley told Reuters Health by
email.
In the statement, the ACP recommends integrating behavioral
healthcare into primary care by removing financial barriers, closing
insurance coverage gaps and using government incentives to train and
educate an adequate number of providers to administer behavioral
health care in the primary care setting.
More research is needed to define the most efficient approaches for
integrating care and efforts should be made to remove the lingering
stigma associated with mental healthcare, both among the general
public and among physicians themselves, the statement notes.
“People might think of behavioral health as stigmatizing and
wouldn’t think of going to specialized care for it,” said Constance
M. Horgan of the Institute for Behavioral Health at the Heller
School for Social Policy and Management at Brandeis University in
Waltham, Massachusetts.
Delivering mental healthcare in the primary care office, where so
many people already go, could help bridge that gap, said Horgan, who
was not involved in the ACP statement.
“There certainly are people who need the specialty system, so the
primary care system certainly should be in a position to refer to
specialty systems,” she said. Though these resources may be
available in many communities, many primary care providers don’t
know about them, or how to hand off a patient into specialized care,
she said.
Placing a behavioral care specialist in primary care offices would
help make those connections, she said.
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“In some cases some physicians may not know how to ask difficult
questions,” like inquiring about signs of alcohol abuse, Horgan
said. Those providers may need specialized training in how to deal
with substance abuse.
The Supreme Court decision to uphold the Affordable Care Act (ACA)
should help to address some of the barriers to integrated care, she
said.
“Not only has the ACA helped increase the number of people with
comprehensive, affordable health coverage, but it requires many
plans to cover essential health benefits that include mental health
and substance use disorder services including behavioral health
treatment and preventive services (e.g., substance abuse screening)
without cost sharing,” Crowley said.
“We hope that all states will choose to expand Medicaid coverage,
which includes behavioral health and medical benefits,” he added.
“Physicians can establish professional relationships with behavioral
health providers to facilitate referrals when needed; they can
educate themselves on screening and diagnostic protocols and
understand what, if any, treatment they can provide their patients;
they can educate their patients on behavioral health issues,”
Crowley said.
SOURCE: http://bit.ly/1HvRVK1 Annals of Internal Medicine, online
June 30, 2015.
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