Behavioral Health vs Mental Health Integration
Hello CFHA Crew,
We are planning on integrating psychiatry into our existing family medicine residency aside from existing behavioral health traditional and more integrated services. In describing our program, we had a discussion around what term to use: Behavioral Health vs Mental Health Integration?
I grew up in integrated primary care where we called it behavioral health integration, a term that is also widely used in the integrated care literature or throughout this listserv. However, I was informed by a faculty member, that apparently in the psychiatry world, the term mental health integration is used, rather than BH integration, which left me a bit perplexed.
So, I was wondering if someone could enlighten me about the term mental health integration and its use - specifically in the psychiatry realm and if others use the mental health integration term (vs BH) when psychiatry and BHCs work in primary care to describe the service. I was told it is a newer movement - but honestly, I have not been aware of a term/name change.
I would also be grateful for any literature citations of the difference between the two terms.
Thanks in advance for your thoughts,
I don’t think your source speaks for the psychiatrists most involved in integrated care. Lori Raney wrote an authoritative book in 2014 called “Integrated Care: Working at the Interface of Primary and Behavioral Health Care.” I suspect any strong preferences are regional.
For what it’s worth, our program at Mayo is called Integrated Behavioral Health. Our group includes psychiatry, psychology, social work, and nursing. I personally like the behavioral health option better since it seems to allow for addressing behavioral health issues that are not always linked to a DSM diagnosis but that impact health. I suppose it might depend on what one sees as the denominator – all patients with mental health diagnoses, or all primary care patients? The behavioral health option seems more inclusive.
I am not surprised that there are more than one opinions however. Ask two psychiatrists…
As Mark said, Behavioral Health is more inclusive than mental health diagnosis and can include health related behaviors, such as smoking, or adherence to treatment for a medical condition, those items that are treated and billed under Health & Behavior Codes rather than mental health codes. Its a large umbrella and mental health is one important piece of a larger group of behaviors.
I propose an alternative perspective that in an effort to be inclusive we may minimize the significance of mental health conditions and substance use disorders with other health behaviors. Additionally, there is a movement back to addressing mental health and substance use without using the generic behavioral health label.
If we want to be inclusive, let’s just say “integrated health services. “
I have been following this thread and enjoying it immensely! I love this idea that Dave suggests!
“Integrated service delivery is “the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money.” WHO 2008
As a nurse I prefer integrated care. I absolutely agree that when discussing integration using behavioral health over mental health is more inclusive. Training and teaching new staff and students I find it is more accurate, less intimidating and more reflective of the care provided.
I use the term integrated care to describe the integration of behavioral health, physical health, and social services. I believe behavioral health encompasses both mental health and substance abuse disorders.
Integrated care describes the setting in which services are offered and collaborative care describes the process of providing interdisciplinary patient-centered care.
My work focuses on people at risk for and diagnosed with HIV. The rates of behavioral health conditions in this population are higher than the general population and people are often in need of patient-centered coordinated care to address their complex health and social service needs.
BLUF: my comments below notwithstanding, this discussion may seem important to us but is irrelevant to our patients. Our goal is to achieve integrated healthcare whether in primary care, surgery, oncology, rehab or whatever.
That said, someone needs to lie down in the road in front of this bandwagon. This is really nothing new, but started when the National Council defined itself with the term “behavioral” 25 years ago. In numerous focus groups with patients in multiple settings over many years I’ve heard people being helped with pain management, tobacco cessation, etc bristle at the term mental and individuals with mental illnesses bristle at their mood or hallucinations being called behavior. Thus I still keep the terms separate. Common lexicon does use behavioral as the overarching term but I reserve the right to ignore that in my work and thought. Again, it matters little to patients if we simply address what’s important to them without calling it anything.
Just a bit of context, building on Andrew’s comments- the term “Integrated care” has a much broader meaning to most health care administrators and “behavioral health” barely makes the conversation. Examples of integrated care are Kaiser, The V A, and compared to the US, many of the health systems around the world. I feel a bit presumptuous and overstepping using “integrated” with out “behavioral health”.
For more information, as an example, read the recent WHO report on integration ( http://www.euro.who.int/__data/assets/pdf_file/0005/322475/Integrated-care-models-overview.pdf)
You will see that behavioral health or psychology or mental health are barely mentioned. It’s the same application of systems thinking as we apply in our behavioral health world but on a much grander scale.