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Fostering Sustainable, Integrated Medical and Behavioral Health Services in Medical Settings

Ron Manderscheid, PhD; and Roger Kathol, MD
[+] Article, Author, and Disclosure Information

From the National Association of County Behavioral Health and Developmental Disability Directors, Washington, DC, and University of Minnesota, Minneapolis, Minnesota.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1693.

Requests for Single Reprints: Ron Manderscheid, PhD, National Association of County Behavioral Health and Developmental Disability Directors, 25 Massachusetts Avenue NW, Suite 500, Washington, DC 20001; e-mail, rmanderscheid@nacbhd.org.

Current Author Addresses: Dr. Manderscheid: National Association of County Behavioral Health and Developmental Disability Directors, 25 Massachusetts Avenue NW, Suite 500, Washington, DC 20001.

Dr. Kathol: 3004 Foxpoint Road, Burnsville, MN 55337.

Author Contributions: Conception and design: R. Manderscheid, R. Kathol.

Analysis and interpretation of the data: R. Manderscheid, R. Kathol.

Drafting of the article: R. Manderscheid, R. Kathol.

Critical revision of the article for important intellectual content: R. Manderscheid, R. Kathol.

Final approval of the article: R. Manderscheid, R. Kathol.

Administrative, technical, or logistic support: R. Manderscheid.

Collection and assembly of data: R. Manderscheid, R. Kathol.

Ann Intern Med. 2014;160(1):61-65. doi:10.7326/M13-1693
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The integration of behavioral health (BH) and primary care services has been the subject of considerable attention for almost a decade. Such work has been motivated by the prevalence of chronic health problems in persons with BH conditions and correspondingly high rates of early death. Service integration efforts typically included cross-referral or bidirectional efforts to add some features of primary care to specialty BH settings or the reverse. This article proposes a third approach based on full service and financial integration and shows how it differs substantially from the other 2 models. This new model has the potential to bring much-needed BH services to persons served in primary care settings who have these conditions, while fostering integrated services in specialty settings for those with the most severe mental or substance use conditions. The Patient Protection and Affordable Care Act could provide a valuable opportunity to implement this third model.


Grahic Jump Location

Three models of integrated care delivery.

BH = behavioral health; Med = medical.

Grahic Jump Location




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