Our health care system is plagued by a lack of coordination. Fragmentation is particularly acute in the mental health system, affecting both cost and quality.

A large percentage of individuals with mental health conditions rely on primary care for treatment, making it important these settings adequately address these problems. People with severe mental illnesses who are served in our public mental health systems die on average 25 years prematurely, due to a range of common chronic conditions that often go unrecognized and untreated. Payment barriers also hinder the integration of the behavioral and general health needs of patients. The failure to treat both general and mental health conditions produces poorer outcomes and higher costs.

A medical home can help integrate care and current health reform proposals could give it a boost. The concept behind the medical home model has been around for awhile. It was developed in pediatrics and was designed to allow children and adolescents suffering from severe illnesses to be treated in the home as opposed to the hospital.

In a medical home, traditionally a primary care provider (such as a family doctor, internist, pediatrician or nurse practitioner) gets paid to serve as the main point of contact for a patient and coordinate care among specialists and other community resources. It becomes a place where patients can successfully access resources that may help them change behaviors, reduce risk factors, or even give them access to services that will help those risk factors from even occurring.

Other kinds of providers, including behavioral health specialists, should also be encouraged to develop medical homes for people in mental health and addiction treatment. The size of a clinical practice can either facilitate or hinder the ease of implementing a medical home. In large, multi-specialty clinics coordination can be easier. In smaller physician practices community health teams, can improve coordination of care and integration of services. Individuals who have the lived experience of mental illness or addiction and who are appropriately trained and supported can provide valuable peer support services that likely will increase access and engagement in services.

Former First Lady Rosalynn Carter has been a leader in the medical home effort and through the Carter Center has fostered a dialogue that has brought individuals from various disciplines together to highlight the importance of medical homes for persons with mental health and substance use conditions and to highlight the importance of the inclusion of behavioral health services in any medical home model.

Medical homes are also gaining a place within the ongoing debate over health reform. Both the House and Senate health reform plans include steps to encourage development of medical homes and community health teams to improve care coordination.

The Senate would create an option for states under Medicaid to establish medical or health homes. This section specifies that individuals with serious mental health conditions are a priority population for these services. In addition, behavioral health providers and community mental health centers are on the list of providers who would qualify for funding under this new option. The Senate bill also includes funding to support co-location of primary care in community-based mental and behavioral health settings. It would create a program to fund community health teams.

The House plan is different. It would establish pilot programs in Medicare and Medicaid to encourage development of medical homes. But it doesn't require behavioral health specialists be included on the treatment teams or that mental health or addiction treatment facilities be allowed to serve as medical homes. However, it would establish innovations in interdisciplinary care training programs to develop and evaluate models that integrate general, mental and oral health services.

It's important we promote the medical home and find room for mental health. By integrating care, we improve quality, expand access and reduce costs-and create better outcomes for millions of Americans.

About the Author

David Shern, PhD

David Shern, Ph.D., founded the National Center for the Study of Issues in Public Mental Health. He currently heads Mental Health America.

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