Texans deserve more integrated health care

Photo by Julianne Showalter

Our bodies and minds are one. Physical health and mental health are inextricably bound together. But we can easily lose sight of how poorly and infrequently this basic truth is reflected in the systems we’ve developed to care for ourselves and one another.

Illustration by Federica del Proposto | Click image to enlarge

Consider the complex relationship between our weight and our state of mind. Depression and anxiety can lead to weight gain. Obesity increases the risk of diabetes, high blood pressure and other chronic conditions. This can lead to the need for long-term treatment regimens, which can be compromised by the depression and anxiety that caused the weight gain in the first place. People who are depressed and anxious may have a harder time taking their medicine on schedule or being motivated to follow their treatment plans.

This isn’t a hypothetical concern. Sixty-eight percent of adults with a mental health condition also have one or more chronic physical conditions such as obesity, high blood pressure, heart disease, or diabetes.

In one sense, we know all this. Our doctors and nurses, psychiatrists and social workers also know it. They work hard to treat us as holistically as possible given their training and contexts.

The problem is that their training and contexts too often work against truly integrated care.

Most people seek help for mental health and substance abuse problems from their primary care physicians. Yet in primary care, mental health and substance abuse problems frequently go undetected and untreated. Even when difficulties are recognized, the care is rarely optimal. The primary care setting is designed to manage acute medical problems, and providers rarely have time or the training to conduct an adequate assessment, provide patient education and collaborate with other providers.

Sadly, the reverse also is often true. Most psychiatrists do not conduct physical examinations of their patients and fail to recognize more than half of their existing medical conditions. Evidence also suggests that mental health providers frequently fail to obtain and monitor vital signs and laboratory tests recommended for prescribed medications.

The results of these dynamics are stark: Chronic conditions are exacerbated by poor adherence to treatment regimens, and mental illness is exacerbated by undiagnosed physical problems.

We’re not doomed to this situation. There is a rapidly growing evidence base demonstrating that integrated models of service delivery can cut costs and improve outcomes for people with complex health care needs.

In Texas, we’ve already taken some important initial steps toward a more integrated model of care, most notably with the passage in 2013 of Senate Bill 58, which directed the Health and Human Services Commission to integrate behavioral health into the state managed care system.

The legislation also created the Behavioral Health Integration Advisory Committee, which was charged with developing recommendations to create a more truly integrated system of care for all Texans.

Some of the principles of the committee’s mission include a more holistic treatment approach, more patient-provider collaboration, improved payment mechanisms and better systems for measuring outcomes. Collectively, these principles outline a concrete and coherent vision for the future of integrated care in Texas that, if realized, will bring our practices into much better alignment with our best intentions.

But there is still a long way to go. We need more health clinics and organizations to practice truly integrated care and implement policies that promote it across the entire spectrum, from the front intake desk to the CEO suite.

Under the best of circumstances, the implementation of integrated care in Texas will be a long, complicated process. We have an unusual degree of consensus across the political spectrum on the general direction in which we need to go, and on the principles that should guide us while getting there. What we need now is the political will and the sense of moral urgency to get us moving.

Octavio N. Martinez Jr., MD, Hogg Foundation for Mental Health

Octavio N. Martinez Jr., MD, Hogg Foundation for Mental Health

David Lakey

Associate vice chancellor for population health, UT System

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