Integrated Care and Psychiatric Rehabilitation

A lot has been said in the past few years about integrated care models. There are several such models that blend or partner primary care and behavioral health services to varying degrees. This movement toward integrated care has the potential to cause apprehension among psychiatric rehabilitation practitioners who have traditionally been connected to organizations that focused exclusively on mental health. They may view this shift as a threat to their role in providing services to the populations they have long served, and they may wonder how their practice fits in to the primary care setting. I believe integrated care will enhance the ability of psychiatric rehabilitation practitioners to provide services, rather than take away from it.

You see, I basically grew up in integrated care. The agency at which I work began as a mental health center in 1960 and began outreach to primary care in 1980. Our first primary care clinic was opened in 1984, and we began involvement in the Federally Qualified Health Center program in 1987. I started work here in 1986, in a traditional mental health day treatment program. I am also a licensed practical nurse, so it seemed logical to me that we would address general health issues in our program too. And we did. We provided psychiatric education in the areas of healthy eating and exercise, and physical activity was a routine element of our day. We linked people with primary care providers and, when needed, we went with them to appointments. We helped people understand the instructions they were given by the primary care providers or specialists, and we helped them get more information about their health status and what they could do to improve their health. We worked with both groups and individuals to improve health literacy. We still do.

As time went on, our involvement in primary care increased. Our integrated clinics have genuinely blended care, in which behavioral and primary staff share space and come together as one treatment team. And psychiatric rehabilitation remains a service that we can offer. Our program receives referrals from the primary care providers as well as from behavioral providers; non-integrated behavioral providers might not realize it, but primary care providers address behavioral health needs many times each day!  Psychiatric rehabilitation providers collaborate with both primary care and behavioral staff to help those persons we serve achieve the highest level of health possible.

We have pushed the integrated care model further by designing one program for persons with diabetes that uses psychiatric rehabilitation space, employees, and a psychiatric education approach along with individual time with the primary care provider. Although this particular program was originally designed for persons with significant mental health issues, persons without a history of significant mental health issues can benefit from it as well, and these persons may also be referred for attendance.  Nursing personnel and a clinical psychologist also participate in the program, and the psychiatric staff demonstrates a diabetes-friendly meal. The focus is on acquiring and strengthening the skills that are needed for successful self management. This group meets once a month.

Peer recovery specialists who provide care in the integrated environment have also joined our team. Peer specialists provide individual and group services that often address primary care needs; they receive referrals from primary care providers as well as from mental health therapists. The State of Tennessee has assisted with funding for peer services and has provided peer counselors with training to facilitate disease self management workshops.

So how has integrated care affected our psychiatric rehabilitation program?  It has given us access to a broader range of expertise and it has made it easier for us to access primary care providers for information or help when we need it. It has helped us be part of a team that we know is providing the most comprehensive services possible. Finally, integration helps us work to truly erase the divisions that create mental health stigma. It is not physical health care or mental health care, it is plain health care