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Discussion Briefs

Integrating Mental Health in the Primary Care Setting: The Case in the U.S. and Abroad

One in four adults −approximately 61.5 million of Americans− experiences mental illness in a given year. One in 17 − about 13.6 million − live with a serious mental illness such as schizophrenia, major depression or bipolar disorder. (The National Alliance on Mental Illness, NAMI. 2013) Globally, people with mental disorders experience disproportionately higher rates of disability and mortality. (World Health Organization. 2013) Between 76% and 85% of people with severe mental disorders receive no treatment for their disorder in low-income and middle-income countries, the corresponding range for high-income countries is also high: between 35% and 50%. (WHO. 2013)

In the U.S., treatment of mental illnesses has gone from an inpatient model to an outpatient and community-based model. Since November 2013, health insurance companies are required to treat mental illness and addiction the same as physical illness as part of the Affordable Care Act (ACA). In poor and developing countries, the WHO states, mental health is often neglected and the quality of care is poor with very few mental health professionals. There, the WHO argues, redirecting funding for mental health towards community-based services would allow access to better and more cost-effective interventions for more people. A more recent model, however, calls for the integration of mental health in the primary care setting, and the U.S. Agency for Healthcare Research and Quality (AHRQ) provides reports that review existing models of integration, highlighting pros and cons, and discuss the role of various health professionals as well as the potential for Health IT. From November 18-22, 2013, experts from NAMI, The Center for Health Care Strategies, Boston Children's Hospital, Harvard Medical School, and Partners In Health, discussed this topic with GHDonline members in a virtual Expert Panel organized as part of the US Communities Initiative.
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