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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Reconnecting the Head to the Body: National Council Longtime Champions of Integrated Care

June 25, 2018 | Healthcare | Comments
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Integrated physical and behavioral health care is a concept whose time has come. Integrated care is about providing trauma-informed, holistic care to seamlessly address all health concerns of patients and their families. In practice, it means:

  • Checking a person’s blood pressure when they come in for a medication visit with their psychiatrist.
  • Screening for substance use and administering the PHQ-9 when patients see their primary care physician for their annual physical.
  • Moving care upstream by screening for behavioral health concerns during well-child visits.

Ultimately, integrated care means recognizing that a person’s overall health is the sum of the health of their body and their brain. At a time when suicide rates continue to increase, and both physical and mental health problems play a role, we haven’t a moment to lose.

But integrated care is about more than treating individuals. It’s about changing the culture to one in which integrated care is not seen as an add-on but as integral to providing the best possible care to people with mental illnesses, substance use disorders and physical health problems.

Through the Center for Integrated Health Solutions (CIHS), the National Council has been leading a national conversation about population health, prevention and early intervention and addressing health disparities across the lifespan. We are partnering with local and national organizations, states and federal agencies to change practice, enhance workforce skills, measure outcomes and develop and disseminate best practice tools.

We do this work because the need is great. Individuals with the most serious mental illnesses and substance use disorders are at greater risk than individuals without these conditions for diabetes, high cholesterol and high blood pressure. They are more likely than members of the general population to smoke cigarettes.

Together, these factors put individuals with serious mental illnesses and substance use disorders at higher risk for heart disease, cancer and premature death. That’s why the Interdepartmental Serious Mental Illness Coordinating Committee – chaired by Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz – recommended “bidirectional integrated mental health and primary care services” for individuals with serious mental illnesses and serious emotional disturbances.

Leading the Way

The National Council is at the forefront of these efforts. Since 2009, we have operated CIHS, jointly funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA). CIHS is the only national center providing assistance not only to federal grantees, but also to states, local governments, organizations and individuals interested in transforming health care in their communities.

Through CHIS, we have provided technical assistance and training to HRSA’s safety net provider organizations, 214 grantees of the SAMHSA Primary and Behavioral Health Care Integration (PBHCI) program, three state grantees of SAMHSA’s Promoting Integration of Primary and Behavioral Health Care initiative and eight states selected for the Certified Community Behavioral Health Clinic (CCHBC) demonstration.

But our work is about more than numbers of grantees and types of programs served. It’s about people. People like Kiki, a client of the Bond-Apalachee Wellness Integration Center (BAWIC) in Tallahassee, Fla. Kiki hadn’t seen a doctor in five or six years and was unaware that she had several serious physical health problems, including high blood pressure, high cholesterol and diabetes. At BAWIC, she started taking diabetes classes and learned about the importance of eating well and controlling her weight. She has lost 30 pounds and says the staff at BAWIC “have definitely done a lot for me.”

And Kiki is not alone. PBHCI clients who have chronic physical health conditions are getting better. They are controlling their diabetes and their blood pressure and getting a handle on their smoking. They are exercising and eating healthy, many for the first time. Moreover, they have fewer visits to the emergency department and less involvement in the criminal justice system, and they are functioning well in everyday life. That’s a win-win!

Changing the Culture

Grants like PBHCI help launch system transformation needed to adopt sustainable change, which is critical to ensure continuity of care. Success entails building leadership buy-in, developing a common vision for integration and addressing regulatory and policy barriers. Here again, I’m pleased to report success.

Recently, we surveyed a group of PBHCI grantees from three previous cohorts. Results indicate that grantees are forming positive relationships with their primary care partners, identifying alternative funding early in the grant, developing their existing workforce and offering billable services. As a result, when grant funding ended:

  • 72 percent sustained or enhanced primary care services,
  • 90 percent sustained or enhanced care coordination services,
  • 78 percent sustained or enhanced wellness activities, and
  • 65 percent sustained or enhanced peer support services.

PBHCI grantees are changing the culture of health care in their communities. So, too, are the CCHBCs established by the Excellence in Mental Health Act. In exchange for providing behavioral health services integrated with primary care, CCBHCs receive reimbursement that covers their cost of providing comprehensive, evidence-based treatment. Halfway through the two-year demonstration project, CCBHCs are transforming access to care in their communities. And CIHS is a valuable resource to these practitioners.

We Can Help

Clearly, integrated physical and behavioral health care is not the wave of the future or the “flavor-of-the-month” intervention. It’s the single most important way to ensure that people with multiple and complex conditions receive the comprehensive care they need. And I’m proud that the National Council is leading the way.

How can we help you succeed at promoting integrated health care in your communities? Write to us at