THE MENTAL AND PHYSICAL HEALTH CONNECTION

FROM:  U.S. VETERANS ADMINISTRATION
Mental and Physical Health – A Critical Connection 
The Case for Integrated Care
May is Mental Health Month, a time VA dedicates to raising awareness of Veterans’ mental health conditions and focuses on the many programs VA has to help achieve mental wellness for all.

A workforce of over 20,000 VA staff caring for the mental health of America’s Veterans is scheduled to increase by another 1,900. See sidebar story.
The mission of VA’s Office of Mental Health Services is to maintain and improve the health and well-being of Veterans through excellence in health care, social services, education, and research.

It has long been recognized that mental health and physical health problems are interrelated components of overall health and are best treated in a coordinated care system. In 2007, VA formally began an initiative to assure that coordination takes place — integrated care is now present in almost every VA medical center and an increasing number of community based outpatient clinics.

According to Dr. Andrew Pomerantz, “There have been many calls for full integration of mental health into the rest of health care over a decade, beginning with the Surgeon General’s report in 1999 and later repeated by The Institute of Medicine, the New Freedom Commission, the Agency for Healthcare Research and Quality and many others.”

Dr. Pomerantz is VA’s National Mental Health Director for Integrated Care. He works collaboratively with the National Primary Care Director for Integrated Care.
“One goal of integrated care is to elevate mental health care to the same level of urgency and intervention as other health conditions.”

The important context of integrated care recognizes several facts:
Primary care provides opportunities to screen for unrecognized mental illness. Without ready access to mental health care, these conditions are not always treated.

Many patients prefer treatment in primary care settings and are not willing to attend appointments in a mental health clinic.

An established relationship with a primary care team fosters engagement in treatment. Adding mental health experts to that team expands the reach of what can be accomplished without referral to mental health services.

Health conditions do not always neatly fall into “physical” and “mental health” categories. They are closely interrelated. Outcomes of many general health conditions can be improved if the psychological and behavioral problems are attended to.

As Dr. Pomerantz explains, “We have repeatedly found that once integrated care programs are implemented, more patients with mental illness receive effective treatment than when they were treated in separate systems.

“Integrated care programs offer same-day appointments while the patients are already in the primary care clinic. This eliminates the attrition we generally see when patients have to wait days or weeks for an appointment in another clinic. If a patient has to wait a month for a mental health appointment, there’s almost a 50% likelihood that he or she will either cancel it or not show up when the time comes.”

Elevating Mental Health Care
The objective is to integrate care for Veterans’ physical and mental health conditions, improve access and quality of care across the spectrum of illness severity, reduce the stigma often associated with seeking help for mental illness, and allow treatment in mental health specialty settings to focus on persons with more severe illnesses. This greatly enhances the effectiveness of mental health treatment for those with more serious mental illness.

One goal of integrated care is to elevate mental health care to the same level of urgency and intervention as other health conditions. It provides the expertise to assure that mental disorders are effectively treated.

Dr. Pomerantz describes how a Veteran with co-occurring disorders is helped by integrated care. “We know, for instance, that outcomes for patients with diabetes are improved when we pay as much attention to patients’ mood as we do to their blood sugar.”

He adds, “Primary care practitioners are a critical link in identifying and addressing mental disorders and have often been called the ‘de facto mental health system,’ since most people with mental illness never make it to specialty mental health care. Opportunities are missed to improve mental health and general medical outcomes when a mental illness is under-recognized or under-treated in primary care settings.

“Until the establishment of integrated care, such under-recognition and under-treatment were the norm in primary care, despite the best intentions of primary care providers.”

Discussion Website Lets Vets Share
One avenue of treatment is the benefit Veteran patients receive from talking about their situation with other Vets. A unique VA website lets Veterans share problems and solutions.

MakeTheConnection.net is a website where you will hear inspiring stories of strength and learn what has worked for other Veterans. You will discover positive steps you can take, all in the words of Veterans just like you.

The Veterans Health Administration (VHA) provides specialty inpatient and outpatient mental health services at its medical centers and community-based outpatient clinics. In addition, readjustment counseling services are available for Veterans and their families at Vet Centers across the nation. All mental health care provided by VHA supports recovery, striving to enable a person with mental health problems to live a meaningful life in their community and achieve their full potential.