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

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.