On the Integration of Mental Health & Primary Care

The disconnect between care and reimbursement for mental health services and other kinds of clinical services suggests just how deeply mind-body dualism pervades Western and American culture, despite the best efforts of many champions over many, many decades.  The beast lives, as I put it in my dissertation.  Thus, the news of a WHO Report on the need to integrate mental health care into primary care is welcome, though I admit it seems almost ridiculous to me that justification is needed for the notion that caring for those suffering from mental and emotional illnesses  is crucial to improving population health, let alone being important to lessening stigma, centering marginalized populations, and caring for persons with disabilities.

Here are some of the details of the Report, which may be downloaded as a PDF here:

Integrating mental health into primary care
A global perspective

Michelle Funk, Department of Mental Health and Substance Abuse, World Health Organization
Gabriel Ivbijaro, Wonca Working Party on Mental Health, London UK
World Health Organization and World Organization of Family Doctors (Wonca) 2008

Available online PDF file [224p] at:
http://www.who.int/mental_health/policy/Mental%20health%20+%20primary%20care-%20final%20low-res%20140908.pdf

“….This report presents the justification and advantages of providing mental health services in primary care. At the same time, it provides advice on how to implement and scale-up primary care for mental health, and describes how a range of health systems have successfully undertaken this transformation.

Mental disorders affect hundreds of millions of people and, if left untreated, create an enormous toll of suffering, disability and economic loss. Yet despite the potential to successfully treat mental disorders, only a small minority of those in need receive even the most basic treatment.

Integrating mental health services into primary care is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. Primary care for mental health is affordable, and investments can bring important benefits.

Key Messages:
1. Mental disorders affect hundreds of millions of people and, if left untreated, create an enormous toll of suffering, disability and economic loss.
2. Despite the potential to successfully treat mental disorders, only a small minority of those in need receive even the most basic treatment.
3. Integrating mental health services into primary care is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need.
4. Primary care for mental health is affordable, and investments can bring important benefits.
5. Certain skills and competencies are required to effectively assess, diagnose, treat, support and refer people with mental disorders; it is essential that primary care workers are adequately prepared and supported in their mental health work.
6. There is no single best practice model that can be followed by all countries. Rather, successes have been achieved through sensible local application of broad principles.
7. Integration is most successful when mental health is incorporated into health policy and legislative frameworks and supported by senior leadership, adequate resources, and ongoing governance.
8. To be fully effective and efficient, primary care for mental health must be coordinated with a network of services at different levels of care and complemented by broader health system development.
9. Numerous low- and middle-income countries have successfully made the transition to integrated primary care for mental health.
10. Mental health is central to the values and principles of the Alma Ata Declaration; holistic care will never be achieved until mental health is integrated into primary care….”

Content:

Executive summary
Introduction

PART 1: Primary care for mental health in context
Chapter 1: Primary care for mental health withina pyramid of health care
Chapter 2: Seven good reasons for integrating mental health into primary care

PART 2: Primary care for mental health in practice
10 principles for integrating mental health into primary care
Argentina: Physician-led primary care for mental health in Neuquén province, Patagonia region
Australia: Integrated mental health care for older people in general practices of inner-city Sydney
Belize: Nationwide district-based mental health care.
Brazil: Integrated primary care for mental health in the city of Sobral
Chile: Integrated primary care for mental health in the Macul district of Santiago.
India: Integrated primary care for mental health in the Thiruvananthapuram District, Kerala State.
Islamic Republic of Iran: Nationwide integration of mental health into primary care
Saudi Arabia: Integrated primary care for mental health in the Eastern Province
South Africa: Integrated primary care services and a partnership for mental health primary care – Ehlanzeni District, Mpumalanga Province, and Moorreesburg District, Western Cape Province.
Uganda: Integrated primary care for mental health in the Sembabule District
United Kingdom of Great Britain and Northern Ireland: Primary care for mental health for disadvantaged communities in London

Report conclusions
Annex 1: Improving the practice of primary care for mental health

(h/t EQUIDAD listserv)

Comments

[Kelly]

Thanks for the information on mental health. The PDF file you included was extremely helpful!!!

We recently wrote an article (http://brainblogger.com/2009/01/02/work-and-mental-health/ ) on mental health at Brain Blogger (http://brainblogger.com/ ). Panic attacks happen to many people all across the country. But what causes panic attacks? How do you avoid them?

We would like to read your comments on our article. Thank you.

Sincerely,
Kelly