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Are we still talking about ‘integrated care’? Where are we and what’s going on…

Entering the health and human service world for my vocation, some 30+ years ago, one of the first expressions I heard was ‘co-location’…’we have to have co-location of services’. Being new to the mental health arena, but having listened to the rational for such a concept, I thought…’of course, this makes sense-we should have mental health and physical health care joined…and if they’re in the same place, all the better’!

So…here we are 30+ years later and now it is ‘integrated care’…’we need to take care of the whole person’. Wow…what a long way we have not come! So…why haven’t we moved very far…and how do we get moving now?

Well…there are many reasons for the ‘why haven’t we moved far’ question. Some reasons are understandable-like we live in a highly specialized healthcare world and not many areas truly talk to each other…other reasons are less-understandable…like turf wars and cross-purpose and often pathetic funding for vital services.

The need still exists though-we still need ‘Total Person’ care…we must make sure each individual has all the needs addressed. ‘Well…of course, we do’, you say, but it still is easier said than done. So what is needed structurally or otherwise to make ‘integrated care’ more than just a slogan.

First, there needs to be an understanding of who will do what, where, why, and how. Sounds like Journalism 101…and in some ways, it is. The mental health, intellectual/developmental disability, and substance use disorder world (MH/IDD/SUD-sometimes generically referred to as behavioral health-BH) can look to the overall physical healthcare world for examples of what is happening globally. The size of the specialty care world seems to grow each day. MH/IDD/SUD can see itself as one of those specialty care provider areas-and physical healthcare will be truly grateful for the relationship and assistance that can come from the BH world. However, the BH world must concisely and precisely define what it does and how so that the general healthcare world sees it as a crucial partner for the good of all served-whether someone has a specific disability or diagnosis…or is simply in need of additional supports and services.

Second, there needs to be a clear understanding of who the hub provider for the individual being served is and who the spokes are…in common terms today, we are talking about the ‘medical home’. Rarely are all providers of any type serving one individual effectively linked-whether that’s through an electronic health record or other means. However, via a medical home/hub and spoke model, the communication can be made much simpler and effective. We’ll be looking at this concept more in-depth in upcoming posts.

So who is doing this right? There are actually several great examples of States, regional authorities, and local areas doing amazing work in the area of integrated care. Over the coming months, we’ll be featuring initiatives by States such as Indiana, regional authorities one in the Piedmont and Foothills of North Carolina, and the work of organizations and agencies like Fountain Model Clubhouse programs for adults with mental illness and co-occurring illness. Clubhouses have long been a leader in Total Person care, but have rarely seen their model and influence move to a larger platform within the healthcare environment. We’ll look at the dynamics that have hindered that broader impact. Finally, we’ll be hearing from some leaders and some front line folks in the world of behavioral health and get their perspectives on where we are with integrated care and how we can truly get to the next level.

Stay tuned…there’s a lot to look at…and we’ll want you along for the whole ride-and we’ll want to hear your views as well! Until then, all the best…and here’s to each, Total, one of us!
John Tote