Posted By Ben Miller,
Thursday, January 20, 2011
Updated: Friday, May 27, 2011
| Comments (2)
In the spirit and tradition of Albert Camus,
let us take a moment and dwell in the absurd. Now for you philosophy
majors out there, I am not going to attempt to do justice to true
absurdist philosophy, but rather take great liberties and address the
field of collaborative care. Camus believed that life was absurd in that
human’s constantly seek meaning from life, but have difficulty finding
it. Collaborative care as a field continues to search for meaning. The
ultimate question is where can the field find that meaning and is it
possible to obtain this meaning?
It has been shown for some time that integrating mental health into the larger medical arena leads to better outcomes. While research of this type initially began in specialty medical settings, it has more recently expanded into the general healthcare arena, primary care. As where most people receive their healthcare, primary care identifies more mental health,
treats more mental health, and arguably has the most to do with what
happens "next” with mental health than the mental health system. Still,
in the face of these facts, there remains difficulty integrating mental
health providers into primary care to "streamline” and "defragment” how
we as a healthcare system treat mental health. This fundamentally is a policy issue, and one that has not been tackled.
As I have recently charged the field to do more work in the policy domain for collaborative care (see upcoming Families, Systems & Health
issue), I will not do so here; however, I want to make the point that
much discussion and effort for collaborative care should continue to
include policy whenever possible.
So conceptually, most agree that by integrating we are doing a great
service to patients who would benefit from these services. We have some
research, wonderful stories, and passionate leaders, but we do not have a
firm standing in the healthcare system whereby our efforts are
discussed as often as other "left out” aspects of healthcare such as
prevention, quality measures and enhanced/modified payment schemes. So
how relevant is collaborative care? How mature is the field? I will
argue that there needs to be a tri-fold process that occurs to lead
collaborative care down a road of increased relevancy and maturity
especially as it relates to policy.
- Disruptive Innovation: Each
new integration effort, started, studied and written up should do so
under the auspices that the content can disrupt the status quo and
attempt to address second order change. Papers simply rehashing what we know may not be that helpful
for moving collaborative care forward; no more reviews of how great
integration is – we have plenty of these. We need disruptive research
and innovation that can move the "needle” for collaborative care.
- Policy Briefs:
Sites interested and actively engaged in integration should become
experts on how to write up one-page policy briefs. While stories have a
powerful impact on policy, concise one page policy briefs that highlight
an issue on integration with data (qualitative or quantitative) can be
an even more powerful and persuasive argument for policy makers.
One-page policy briefs, as difficult as they are to write, and write
well, will be a distinguishing characteristic of a mature field where
newly learned information begins to be included in the national dialogue
on healthcare (for example of excellent one pagers see here).
Additionally, policy briefs can accomplish the goal of getting the
community talking about an issue germane to collaborative healthcare and
bring the field more closely together.
- Seeing the Big Picture:
Representing an ideal, a whole (field/movement), rather than a specific
part (my model) means that rapid infusion of the collaborative care
message into policy may be more likely as fewer barriers will be in
place filtering the message. Policies advocating for comprehensive
collaborative healthcare can be inclusive. Since there is much we still
need to know about what strategies work for integration, it is premature
to promote a "standard approach” to integration. However, by grounding
our argument in the inseparability of mental from physical, we can discuss the cost of separating mental and physical, the problem with access
to mental health, and providers desire to have onsite mental health, we
can start to address the "big picture” not simply another workaround.
So you see, collaborative care has a way to go before we can increase
our stage presence on the national healthcare stage. We can get there
faster if we begin to consider how to mature our field by more
comprehensively studying our disruptive integration efforts, writing up
smart, concise policy briefs on said efforts, and recognize
collaborative care’s role in the larger healthcare system.
Is it possible to find our "meaning” as a field or will we continue
to search for meaning without ever finding it? Addressing policy head on
is a proactive way to find our meaning for collaborative care. Because
really, the last thing any of us want is for collaborative care to be a "stranger” in national healthcare debates.
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