Coordinated care – research indicates several important key factors

The Mental Health Foundation, the U.K.’s leading mental health research, policy and service improvement charity, recently released a report, titled “Crossing Boundaries: Improving integrated care for people with mental health problems.” The report established the findings of the Foundation’s inquiry, which ran from April 2012 to June 2013, into integrated healthcare for those with mental illness. Its goals were clearly drawn: Identify good practices, create a set of key messages and stir up the discussion on coordinated care.

Restoring connection
The report authors noted in their preface that since the founding of England’s National Health Service, often called the NHS, in 1948, there has been a strict divide between physical and mental healthcare. In many ways, the two existed in silos and the holistic picture went unviewed. However, the rise of coordinated care has begun to change that, in part thanks to technology, such as behavioral health EHR software.

As the authors explain, the flawed perspective that physical and mental health are essentially separate and should be medically treated as such is an error that needs to be fixed. New research even shows a link, such as the recent journal study “Violent Behavior: A Solution in Plain Sight,” by Sylvia Onusic, Ph.D., which demonstrates that deficiencies in key vitamins, potassium and other minerals could contribute to mental instability and violent behavior. Mental health doesn’t require different specialists working on their own – it needs them to be working together. And furthermore, the authors suggest that while considering the biological and psychological, it’s also important to factor in social components. This means that physical and mental health doctors would work alongside agencies – in the U.S. – such as the Department of Health and Human Services, family services or the justice system.

The team then identified nine factors that the study indicated led to good integrated care that benefited patients most. These are some of the highlights.

♦ Information sharing systems
The advent of EHRs had led to an increase in health information exchange, and systems like this make integrated care models easier to establish than ever. While a coordinated care platform can’t take the place of the human element – excellent doctors and social workers – it can facilitate better dialogue and data sharing. According to the Foundation researchers, advancement in this field should be prioritized.

♦ Shared locations for services
The researchers noted that while merging primary care and specialist mental health into a single organization wouldn’t necessarily improve care for patients, co-located services could have a positive impact. The evidence of the study strongly supported the idea that primary care and mental health specialists sharing a location could offer significant benefits as far as integrated response was concerned.

♦ Multidisciplinary teams
However, the researchers pointed out, while multidisciplinary care wasn’t necessarily effective, certain approaches using multidisciplinary teams showed evidence of benefits. They particularly highlighted interprofessional education and training, so that primary care and specialists better understand their patients’ holistic needs as well as the other corners of the care spectrum itself.

♦ Navigators
This term was coined by the researchers for a proposed role in the integrated care platform. Essentially, this individual would help patients navigate their way through integrated care, helping them understand each service from social care to housing and employment or education. The navigator would also put together the initial plan for coordinated care. But the team stressed that they didn’t want to be too prescriptive about the role, and would instead suggest it as a priority for researchers and pilot programs.

♦ Reducing stigma
Echoing the sentiments of mental health advocates and healthcare workers throughout the world, the researchers also called for a reduction of stigma. Removing the stereotypes and onus of mental illness creates a more prosperous environment for coordinated and integrated care models. The authors stressed that part of this approach meant teaching children about health and healthy living in the most holistic sense.

Mental health and schools
The Foundation’s researchers’ final point about children and mental health education is especially salient right now. The number of stories in the press covering the importance of mental health in the classroom and school system over the past year has risen, both in the U.K. and U.S. According to research quoted in U.K. newspaper The Guardian, nine out of 10 young people with mental health illness in one part of England are impacted by stigma. Sometimes that discrimination comes from friends and parents – or even teachers.

A story from May 2013 on Teach for America’s website made another excellent point. In this day in age, the words mental illness are too often confined to shootings or other tragedies. As much progress as mental health has made in recent years, this stigma continues to plague it. And, according to The National Alliance on Mental Illness, that stigma is part of what keeps more than two-thirds of adults and half of children with diagnosable mental illnesses from receiving proper help in a given year.