Online Program

Facilitators and Barriers to Integrating Physical and Mental Health Care: The Challenges of Converting Policy to Practice

Wednesday, November 4, 2015

Karen Monaghan, PhD MSW MS, Center for Social Policy, University of Massachusetts, Boston, Boston, MA
Background: Integration of physical and mental healthcare has grown in popularity among policy makers as a means to address gaps in the delivery of services, increase patient access to appropriate mental healthcare and reduce stigma associated with mental illness. The Patient Protection and Affordable Care Act (2010) has mandated that Federally Qualified Health Centers (FQHCs) integrate such care.

Methods: This research utilized case-study methods to examine how policy becomes practice, i.e. how policy is developed and implemented in FQHCs. Furthermore, it examined if current integration practices improve patient outcomes. Site selection was informed by a conceptual framework underpinned by theories of stigma, social construction, organizational relationships and street level bureaucracy, and by analysis of background and historical information. Investigators collected and analyzed qualitative data obtained from in-depth interviews, background information, direct observations of agency systems and document analysis (Yin, 2003).

Findings: Facilitators and barriers to successful implementation of integration policy were identified. Challenges to integration included: no one clear definition of integration exists; rather than the development of a multidisciplinary model; mental healthcare has been subsumed into the medical model; and institutional stigma persists in agency policies and practices, thereby limiting access to mental healthcare and reduced health outcomes for people living with mental illness.

Implications: Theory developed from analysis of the data provides a strong underpinning for a new theoretical framework that suggests ways to address challenges so that the original goals of policy decisions are more likely to be achieved.

Learning Areas:

Advocacy for health and health education
Diversity and culture
Provision of health care to the public
Public health or related public policy

Learning Objectives:
Describe facilitators and challenges to the successful implementation of health integration policy. Explain the role of institutional stigma in policy implementation. Identify ways in which the transition from policy to practice may be improved so that the original goals of policy decisions are more likely to be achieved. Demonstrate how analysis of the data identifies means to promote the equitable implementation of policy and increased access to mental healthcare.

Keyword(s): Mental Health Treatment &Care, Public Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: my current research on the implementation of mental health policy is built on many years of study and practice. The experience of individuals living with mental illness was the subject of my MSW thesis and is the focus of my dissertation. I have been a Clinical Social Worker for 14 years and have developed knowledge, skills and values in addressing problems relating to access to mental healthcare at both the individual and agency levels.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.