Integrated Primary Care: The Future of Medical and Mental Health Collaboration (Norton Professional Books)

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Summary: Great book about a concept with some flaws.
Review: Health care providers are familiar with the trend to lower costs. The resulting vocabulary of the 90's has become household words to all health professionals: Managed Care Organizations, medical necessity, capitation, ...to name a few. There are demands to cut costs even more. The idea of collaboration between medical care and psychosocial care has seen a recent increase in popularity as a result. Integrated Primary Care is a modern version of collaboration between the two disciplines. This concept promises considerable cost-containment as well as other benefits to both patients and providers. Yet, from a mental health perspective, it clearly has its limitations. Alexander Blount has brought together severalexperienced clinicians from both disciplines who are pioneers in this field. The resulting edited book, Integrated Primary Care, provides the reader with rationale, instructions, and plentiful examples. This is essential--cutting edge--material for anyone--MD's, nurses, allied health professionals, mental health practitioners,and health care administrators--interested in working in or establishing effective and efficient integration of medical and behavioral care. In his clearly and tightly written introductory chapter, Alexander Blount delineates several levels of collaborative care. Separate medical and mental health practices usually involve low levels of collaboration such as: reports of involvement and calls for information exchange. The model presented in this book has both medicaland behavioral health providers working together regularly in delivering services while representing a unified team response for treatment to the patient. In order to achieve this level of collaboration, fundamental changes in the practice of both professions, particularly that of mental health, must be made. 1. Mental health practices must be located in primary care offices. 2. A joint medical record must be kept. 3. A case coordinator should be designated when many providers are involved. 4. "Mental health providers need to be comfortable and effective in the role of consultant in many cases, since themajority of mental health treatment will continue to be done by the primary care physicians and nurses..." (p.31) 5. Mental health care needs to utilize new practice styles such as episodic encounters and shorter sessions. 6. Mental health consultation should be included earlier in a patient's evaluation. Subsequent chapters are also interesting, relevant, and clearly written. Chapter 2 provides findings concerning psychosocial contributions to specific disease entities such as cardio-vascular, cancer, pulmonary (asthma), gastrointestinal, and rheumatological disorders. This chapter alone provides much valuable information for the mental health practitioner. Chapters 3 through 10 provide instructions and copious examples of integrated primary care over several settings to various populations. Settingsinclude an urban community-Based HMO, rural clinics, and pilot projects. Populations include the underprivileged, frail elderly, women, and the overweight. Chapter 11 addresses training issues. Integrated Primary Care could certainly be a boon to the cost-containment and effectiveness of medical care. It could also provide increased job-opportunities for mental health professionals. However, there remain some concerns with this model of care. Primary care physicians are expected to provide the majority of mental health interventions. Since it is expected that MD's can deliver mental health interventions one (or both) of the following underlying assumptions likelyexist: 1) MD's are as qualified as licensed mental health professionals to deliver behavioral health services; 2) The types of interventions advocated--cognitive/behavioral and solution-focused--are simple enough for non-licensed mentalhealth professionals to learn and practice. From the extensive training that I and my colleagues have received, I know that neither of these two assumptions are accurate. In most of the integrated primary care models presented, patients receive abbreviated mental health treatment. Those suffering from chronic depression or anxiety are often allowed minimal opportunity for encounters with actual mental health professionals. Finally, treatment approaches are either solution-focused or cognitive/behavioral. It seems that the client is made to fit the approach. Modern integrative psychotherapeutic models advocate the opposite. Patients whostand to benefit from other short and long-term approaches may simply not be availed--or even informed--of these methods. For example, short and long-term psychodynamically oriented psychotherapy can provide patients with substantial control over their emotional/defensive reactions which couldultimately contribute to a reduction of physicalsymptom-formation. In the very least, providers should be familiar with prevalent mental health approaches whether or not they are offered by their medical clinic. This information can act as an antidote to any inadvertent "gag rule" that could be applied to the more traditionalapproaches and practices of psychotherapy. In sum, the style clarity, and organization of the book are exceptional. The concept and models of integrated primary care are thoughtfully and clearly presented. However, there are some basic faults in the concept of integrated primary care itself.

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Summary: Best Introduction to the Field
Review: I found this book to be both inspiring, in that it describes and ideal of integrating mental health services into primary care, and practical, in that there are a number of different kinds of implementations described. For anyone who is wanting to get to know the whole field of integrated primary care, it think this is the ideal overview.