Will 'Integration' include CMHCs?Integrating behavioral healthcare with primary care sounds great. After all, mental health and substance use problems affect the entire body. Integrated care promotes a whole health approach and hopefully would reduce the stigma stigma: see pistil.
mark of Cain
God’s mark on Cain, a sign of his shame for fratricide. [O. T.: Genesis 4:15]
scarlet letter surrounding behavioral health Behavioral health was first used in the 1980's to name the combination of the fields mental health and substance abuse. As an example, an organization serving both mental health and substance abuse clients might refer to its practice as behavioral health or disorders.
Yet there is another side to integration that some are very concerned about: what it could mean for behavioral healthcare provider organizations.
On the public side, community mental health centers (CMHCs) have several disadvantages if the push toward integrated care accelerates or intensifies, as the natural "medical home" would be community health centers. CHCs have simpler and more robust funding streams, and they are not associated with the stigma of behavioral health disorders (I suspect the "not in my backyard" mentality is not as great of a problem for them). I have heard that some states are considering dismantling dis·man·tle
tr.v. dis·man·tled, dis·man·tling, dis·man·tles
a. To take apart; disassemble; tear down.
b. their CMHC CMHC community mental health center. networks for some of these reasons.
States would be wise, though, to not assume that CHCs could absorb behavioral healthcare services easily. To start with, patients without behavioral healthcare diagnoses may not be comfortable sharing a waiting room with people who have severe psychiatric and substance use problems. That's the reality of stigma. In addition, CMHCs have long institutional histories of treating these populations that cannot be replaced by just shifting around where clinicians work. CMHCs also have developed nuanced networks of community supports (e.g., schools, homeless shelters Homeless shelters are temporary residences for homeless people. Usually located in urban neighborhoods, they are similar to emergency shelters. The primary difference is that homeless shelters are usually open to anyone, without regard to the reason for need. , child welfare and family service providers, long-term care long-term care (LTC),
n the provision of medical, social, and personal care services on a recurring or continuing basis to persons with chronic physical or mental disorders. providers, and so on) that cannot be easily replaced or assumed.
I asked several members of Behavioral Healthcare's Editorial Board if an "integrated" future is bleak for CMHCs, and their opinions were mixed. Some said it's even worse than I had assumed, but others don't see it as so dire. One noted that if national healthcare reform gains traction, CMHCs should highlight their role as centers of excellence for mental health and substance use care. Another noted that the National Council for Community Behavioral Healthcare already has an initiative under way to incorporate primary care into specialty settings. One board member reminded me that there is no single model of integration and that we should advocate for a flexible system that doesn't reinvent the wheel (jargon) reinvent the wheel - To design or implement a tool equivalent to an existing one or part of one, with the implication that doing so is silly or a waste of time. This is often a valid criticism. , but rather builds upon existing infrastructure. He pointed out that perhaps we should let those who really matter--consumers--decide by giving them the purchasing power Purchasing Power
1. The value of a currency expressed in terms of the amount of goods or services that one unit of money can buy. Purchasing power is important because, all else being equal, inflation decreases the amount of goods or services you'd be able to purchase.
2. to spend their healthcare dollars where they want.
Everyone agrees that integrated care is best, and I know you are dedicated to ensuring that your organizations remain strong contributors to healthcare in your communities. CMHCs probably will not vanish, but they may need to reinvent re·in·vent
tr.v. re·in·vent·ed, re·in·vent·ing, re·in·vents
1. To make over completely: "She reinvented Indian cooking to fit a Western kitchen and a Western larder" themselves. One example is the merger of three community behavioral healthcare organizations to create the nation's largest such provider, detailed in this month's cover story (see page 14). Centerstone, named after the merger's largest partner, sees its size as an advantage, and its executives are encouraging other provider organizations to pursue their own mergers. I suppose that if you don't want to be the underdog, you need to have a larger bark--and bite.
Let me know what you think the field needs to do to make sure CMHCs play a vital role in an integrated future. I will keep my eye on this issue, and let me know what's going on Verb 1. know what's going on - be well-informed
be on the ball, be with it, know the score, know what's what
know - know how to do or perform something; "She knows how to knit"; "Does your husband know how to cook?" in your state.
Douglas J. Edwards