Behavioral Health Integration and Outcomes that Matter to Patients: a Longitudinal Mixed-Methods Observational Study
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Address correspondence to Natalie Royal Kenton, MS, MPH, Center for Outcomes Research and Education, Providence Health & Services, 5251 NE Glisan St, Portland, OR 97213, USA. . Bill Wright, PhD, Center for Outcomes Research and Education, Providence Health & Services, Portland, OR, USA. Kayla Albrecht McMenamin, MPH, Center for Outcomes Research and Education, Providence Health & Services, Portland, OR, USA. Kyle Jones, MS, MA, Center for Outcomes Research and Education, Providence Health & Services, Portland, OR, USA. Maggie Weller, MS, Center for Outcomes Research and Education, Providence Health & Services, Portland, OR, USA. Kristin Brown, MA, Center for Outcomes Research and Education, Providence Health & Services, Portland, OR, USA. Lauren Broffman, PhD, MA, Ro, New York, USA. Laura Jacobson, MPH, OHSU-PSU School of Public Health, Portland, OR, USA. Nicole Bouranis, MA, OHSU-PSU School of Public Health, Portland, OR, USA.
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Journal of Behavioral Health Services & Research, 2020. 1–16. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09691-8
Behavioral Health Integration and Outcomes
WRIGHT ET AL.
systems on the structural aspects of integration versus the experiential components and potential concerns among patients about stigma and discrimination in the primary care settings where integration is focused.
Introduction Mental illness profoundly impacts both personal health outcomes and the systems that work to support health. Worldwide, mental illnesses are the leading cause of reduced disability-adjusted life years1, 2; in the USA, nearly one in five (18.6%) adults likely experience a mental illness in any given year.3 Studies have consistently found that mental illness may precipitate chronic disease, and that chronic disease may precipitate mental illness.4–10 Mental illness is also correlated with a range of poor health outcomes, especially for those who also have other chronic health challenges.11–16 In short, health is a “whole person” affair, and health care systems must respond with structures that acknowledge this basic truth. Behavioral health integration (BHI) has emerged as a core health care transformation strategy for this very reason. Many people use primary care settings as a foundational tool for managing their overall health, and efforts to integrate behavioral health care into primary care are well underway across the nation. Those efforts often hinge on the idea of positioning primary care clinics as “medical homes” that are prepared to address a wide array of whole-person health concerns through better coordinated care,17, 18 often by improving access to, and normalizing treatment for, behavioral health challenges.19–23 Other systems are working the problem from the opposite direction, integrating elements of primary care into behavioral health settings. Research has examined a variety of integrated care models, with approaches ranging from enhanced offsite referral relationships to full on-site integration.24–28 Overall, the evidence supports outcomes such as symp
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