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Integrating Clinical and Mental Health: Challenges and Opportunities

Nearly 45 million American adults suffered from some form of mental illness in 2016. Although there is little change in the estimates of those with mental illness over the last few years, rates of death due to drugs, alcohol, and suicide are increasing. In 2016, about 45,000 Americans age 10 and over died by suicide. Twenty-five states experienced at least a 30 percent increase in suicide rates between 2014 and 2016.

The national opioid crisis has resulted in significant attention to federal policy associated with substance use disorder (SUD). Mental illness along with SUD comprise a broad category of illness commonly referred to as “behavioral health.” In 2016, 44.7 million American adults experienced a mental illness, 20.1 million experienced a SUD, and 8.2 million experienced both?and these numbers are likely underestimated due to lack of identification and issues of stigma. Collectively, more than 1 million people have died from drugs, alcohol, and suicide over the past decade. If these trends continue, the death rate could grow to claim 2 million more lives by 2025.

To the extent possible, the focus of this report will be mental illness. However, where research cited in the report does not distinguish between SUD and mental illness, the Bipartisan Policy Center uses the term used in the research literature. BPC leaders and staff recognize the relationship between the two diseases, including the millions of Americans who suffer from both.

The purpose of this paper is to examine barriers to the integration of clinical health care and mental health services, and to identify policy options for consideration in advancing integration of services. The Agency for Healthcare Research and Quality defines integrated behavioral health and primary care as health care that is the result of a group of primary care and behavioral health clinicians working together as a team, along with patients and their families, to provide patient-centered care. A considerable body of research exists on the benefits of integrating mental health and primary care. In 1996, the Institute of Medicine concluded that treating behavioral health and primary care independently leads to lower-quality care and noted that the integration of services is critical to the diagnosis and treatment of mental illness. Integration of primary care and behavioral health has been linked to cost savings, better treatment outcomes, and lower rates of mortality.

The 1996 Institute of Medicine report recommended eliminating financial and organizational disincentives to the integration of services and developing and evaluating integrated care models. More than 20 years later, a number of care models have been accepted as successful in improving quality of care; however, less progress has been made in eliminating the organizational and financial barriers to integration of care.

BPC’s goal is to identify barriers to integration caused by federal policy, to identify policy options to mitigate or remove those barriers, and to advance mental health care in the United States.

Early Intervention and Targeting of Services

A number of experts raised concerns about the need for early intervention to prevent or delay the development of more serious conditions and the need to focus on children through school-based screenings and treatment. The evidence base for early intervention has grown significantly and increased the availability of data around early intervention, which will help shift the focus of policy interventions to a broader definition of mental illness.

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