Agency News and Notes

Integrated mental and physical health services may help people with depression

A new evidence report—Integration of Mental Health/Substance Abuse and Primary Care—released by the Agency for Healthcare Research and Quality (AHRQ) found evidence that people treated for depression in primary care clinics that provide a coordinated set of services for mental and physical health do better and have fewer symptoms than patients who are treated at sites that just provide health services. However, the report's authors could not identify the mechanism by which this improvement occurred; nor could they determine whether any level of traditional beliefs about integrating mental and physical health services, or simply systematic practice, produced the benefit.

The report, which was cofunded by the Health Resources and Services Administration, Substance Abuse and Mental Health Services Administration, Office of Women's Health, and Office of Minority Health, also found that patients treated in specialty mental health centers appear to benefit when the facilities offer general medical care, but the number of studies was too limited to draw firm conclusions. Prepared by the AHRQ-supported University of Minnesota Evidence-based Research Center in Minneapolis (contract no. 290-02-0009), the report did not find sufficient evidence to draw conclusions about the impact of integrating mental health and physical medicine services on patients with anxiety disorders, alcohol use disorders, or other mental or behavioral health problems.

The authors, led by Mary Butler, Ph.D., found that there are financial barriers to combining mental health and physical health services, including a lack of reimbursement for consultations and communication activities between providers, telephone conversations with patients, and other care management functions, such as payment to care coordinators. Other barriers include staff resistance to change and lack of strong leadership committed to integration. Experts have called for integration because persons with mental health problems often do not receive treatment for their physical disorders. Also, primary care physicians may be in a good position to recognize underlying mental problems in patients who come to them regularly for treatment of chronic illnesses. In addition, patients with mental disorders are more likely to see a primary care physician during the year than a mental health specialist. Combined treatment also may reduce overall health care costs because mental disorders can worsen disability associated with chronic illnesses. 

For details, go to Integration of Mental Health/Substance Abuse and Primary Care, (AHRQ Publication No. 09-E003), at http://www.ahrq.gov/clinic/tp/mhsapctp.htm. Print copies are also available from the AHRQ Publications Clearinghouse.

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