Moving from the Sidelines to the Main Ring: Integrating Behavioral Health, Health, and Social Services

Since the founding of the United States, mental health care has been organized, operated, and financed separately from physical health care. Now, with the passage of the Affordable Care Act, integration of care has become our national policy. 

This lecture will trace long-term and recent developments in the mental health field leading up to present efforts to integrate mental health care with primary care and social services. 

From almshouses, to state mental hospitals, to modern community based programs, care of persons with mental illness has always been separated from other health care. This separation has permitted the field to develop in unique ways, and has produced challenges. Frequently, the health conditions of persons receiving specialty mental health care are not addressed; and, conversely, the mental health conditions of persons who seek care in primary care settings are often overlooked or inadequately treated.  Many people receive no care at all. 

In the modern period, we have rediscovered the seriousness of the health conditions of persons who also have mental illness, and  have quantified its effects in terms of years of life lost. These stark findings have become a major motivating factor in promoting national policy and efforts to integrate care.

 As we go forward, integration efforts will continue in care settings, through medical homes and health homes, and they also will “move upstream” to encompass community and population prevention and early intervention initiatives.

 he current period is one of much anticipation and hope.