Integration of Physical and Mental Health

Philip Hickey, PhD
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Integration of physical and “mental health” care has been a popular topic in psychiatric circles in recent years.  During his term as President of the APA, the very eminent psychiatrist Jeffrey Lieberman, MD, made frequent references to this matter in his posts on Psychiatric News (the APA’s online newspaper).

For instance, on December 6, 2013, Dr. Lieberman, with co-author Richard Summers, MD, wrote:

“The momentum for patient-centered care, the medical home, and integration of behavioral health with primary care creates a new role for psychiatrists.” [Emphasis added]

Paul Summergrad, MD, continued the theme during his presidential term:

“There is now a critical mass of evidence demonstrating the value of integrating general medical care with psychiatric care, providing higher-quality care to larger numbers of patients, and lowering health care costs. Psychiatry is already undergoing rapid shifts in practice, including new ways of working with our primary care colleagues.” [Emphasis added]  September 26, 2014

“In advocacy, the work group’s recommended strategic plan underscored the importance of integrating psychiatry in the evolving health care delivery system, advocacy for the central role of psychiatry in all care settings, and parity implementation and enforcement.” [Emphasis added]  March 13, 2015

And the present President, Renée Binder, MD, has picked up this particular baton with enthusiasm:

“Telepsychiatry is only one of many avenues that will improve access to care. Integrating mental health care in the primary care setting is another avenue, and telepsychiatry can be part of the integrated care model. For example, through the advent of telepsychiatry, a primary care physician may be able to arrange for a patient (while still in his or her office) to be interviewed by a psychiatrist who is geographically distant.” [Emphasis added] September 24, 2015

. . . . . . . . . . . . . . . .

I’ve never been entirely clear about the nature of this proposed integration of psychiatry with primary care, though from what I’ve gathered, it sounds like there will be a psychiatrist, or other mental health worker, attached to primary care practices, either in the flesh or via computer screens.  What has always been crystal clear, however, is that the proposal would entail a huge expansion of the psychiatric net, a diligent ferreting out, so to speak, of those “mentally ill people” young and old, who are “not being served,” and lots of additional jobs for psychiatrists.  I envisage people who go to their GP’s being “ambushed” and encouraged to take a free screening test for depression, intermittent explosive disorder, or whatever.  They will be given the “dire news” that they have incurable chemical imbalances in their brains.  Then they will be given the “good news” that there are “safe, effective medications” that, if taken for life, can keep these “imbalances” corrected and keep the dreadful “diseases” in remission.

And lest my fears be considered groundless, here are some quotes from SAMSHA-HRSA’s Guide to Behavioral Health Integration:  Both SAMHSA (Substance Abuse and Mental Health Resources Administration), and HRSA (Health Resources and Services Administration), are branches of the federal Department of Health and Human Services)

“Integrated care begins with screening all patients for other health (including behavioral health) conditions in addition to the presenting problem.  Similar to hypertension, behavioral health conditions can be ‘silent killers’ in that the patient may not lead with this problem, but these conditions can drive and complicate other health concerns.  If not proactively addressed, mental illness can quietly undermine efforts to improve health status.  Routine screening leads to an organized collection of data.”

“Preventative services with an A or B rating from the U.S. Preventive Services Task Force are covered and available at no cost to the individual.  For behavioral health, that includes screening for alcohol misuse and depression by primary care providers.” [Emphasis added]

“Organizations offering integrated care need to be sure that behavioral health is fully embedded into the practice…”

“A common barrier to integrated care is a lack of knowledge and comfort with prescribing psychiatric medications.  Many primary care physicians have gained foundational prescribing competence, yet PCPs are reluctant to proceed without input from a psychiatrist as more people turn to their PCPs for psychiatric medication.”

So, with a little prodding from psychiatrists, these “reluctant” PCPs will be enabled and encouraged to write more prescriptions for psychiatric drugs.

. . . . . 

I’ve never been aware of any definite timetable for this momentous breakthrough, but a few days ago I received an email from the Colorado Department of Regulatory Agencies on the subject:  SIM Funding Opportunity to Integrate Physical and Behavioral Healthcare.  Here are some quotes:

“We are sending this e-mail to let you know about an exciting funding opportunity for primary care practices interested in providing access to integrated physical and behavioral health care services in coordinated systems. This is a key initiative in Governor Hickenlooper’s efforts to make Colorado the healthiest state.”

and

“Under the State Innovation Model (SIM), Colorado will receive up to $65 million from the federal Center for Medicare and Medicaid Innovation to implement and test its State Health Innovation Plan over a four year period, February 2015 through January 2019.”

I clicked on the SIM link, and here’s what comes up:
SIM Overview

 

There’s also another document titled What Is SIM?  In this document, which is two pages long, the phrase “integrated primary care and behavioral health services”, or some variation on those words, occurs seven times.  Here are some quotes:

“Our vision is bold. Central to transforming the Colorado health system is the integration of behavioral health and primary care, a necessary step in our accelerated achievement of the Triple Aim. Our integration efforts will be supported by an improved public health infrastructure. In turn, behavioral health integration will improve population health by addressing behavioral factors that often impede the management of chronic health problems, especially obesity, smoking and diabetes. Improving access to behavioral health services and programs for most Coloradans is the cornerstone of the Colorado transformation effort.”

Note the final sentence:  more psychiatric service is the “cornerstone” of the state’s transformation effort.  More spurious “diagnoses”; more disempowerment; and more drugs!

“Our vision is attainable, particularly because we are building on important work that is already underway. And Coloradans know how to work together to accomplish big projects. Today, stakeholders throughout the state and from the full spectrum of the health community are on board to collaborate on our SIM proposal. Key partners include eight leading commercial payers and primary care providers covering the majority of the state population.”

Wow!  All the stakeholders are “on board” in the divvying up of $65M.  What a surprise!

“There is urgency in our work. While we have a strong, collaborative foundation, health costs continue to rise, patients receive fragmented care and key population metrics must be improved. SIM will allow Colorado to strengthen our efforts in primary and behavioral care and broaden our reach to most Coloradans.”

Note the phrase:  “broaden our reach.”  And the irony:  we’ll address rising health costs by pumping another $65M worth of psychiatric services into the system!

“The overarching goal of Colorado SIM is to improve the health of Coloradans by providing access to integrated primary care and behavioral health services in coordinated community systems, with value-based payment structures, for 80 percent of state residents by 2019. There is strong evidence that treating physical health, mental health and substance use disorders together will help us take aim at the ever-increasing burden of chronic disease. Our plan, called The Colorado Framework, creates a system of supports, both clinic-based and through expanded public health efforts, to spur integration.”

Note the truly beautiful obfuscation:  “There is strong evidence that treating physical health, mental health, and substance use disorders together…”  will what?  Lead to better outcomes? improve people’s lives? help people get off the disability rolls?  No.  None of these.  The $65M worth of integration will help the state of Colorado take aim at the increasing “burden of chronic disease”.  With all this money and all this integration, they’re going to be able to take aim at the burden of chronic disease.  And there’s strong evidence for this!

. . . . . 

Discussion

Although I’ve focused on Colorado in this article,  similar moves are, or soon will be, underway in other states.

If pharma-psychiatry succeeds in expanding its web of destructiveness in this way, it will be a tragedy of enormous proportions.  More and more people will be “diagnosed” with psychiatry’s so-called illnesses; and drugging rates, already high, will soar to heights as yet unimagined.

This is not the practice of medicine.  This is pharma-funded drug-pushing.

25 COMMENTS

  1. Hi Philip,

    I completely agree with you. Every time someone in the mental health industry comes up with a “new” program or catch phrase, it is just an excuse for not getting people better care or actually working for reducing the causes of emotional distress. These things are always just marketing, letting bureaucrats believe they are doing something, and expanding the inappropriate (ab)uses of psychiatry.

  2. “This is not the practice of medicine, it’s Pharma funded drug pushing.” How incredibly sick our government is advocating and allowing for this expanded psychiatric harm of the U.S. citizens. And are these tax payer dollars, or Pharma dollars, paying for this expansion of iatrogenic harm?

    It seemed to me that the APA push for this started in 2013, just after Insel confessed there was no scientific validity behind any of the DSM disorders, and the UN confessed that “forced psychiatric treatment is torture,” and such.

    And, if this is accepted by many within the mainstream medical community and is pulled off nationwide, I fear that the entire U.S. medical community, some day, will be judged as guilty as the Nazi psychiatrists were during WWII.

    During my 2009 drug withdrawal induced super sensitivity manic “psychosis” / spiritual awakening to my dreams, Jesus supposedly claimed it was time for the final judgement, and all the doctors were going to the lake of fire. I thought that couldn’t possibly ever be true. I know a lot more about the medical industry now, than I did then. I still believe there are decent doctors, thank you, Philip. But if this is pulled off nationwide, I do fear for the souls of the money worshiping medical practitioners.

    The mainstream medical community really needs to wake up, step up to the plate, and stop this. And realize our government is likely advocating for this because it’s been taken over by the exact same “too big to fail” banking families, bankers that profited off financing both our other two world wars. And they are using the doctors as pawns, just as they did pre-WWII, because they must destroy the U.S. economy and dissenters, in order to bring about their NWO. And the Holy Bible forewarns us of this evil takeover. Thankfully, I’m no longer the only one who sees what’s going on, it’s now all over the Internet.

    https://m.youtube.com/watch?v=5hfEBupAeo4

    I pray this is stopped, please wake up U.S. doctors.

    • SE,

      Unfortunately, I have seen evidence of this in my PCPs office as I previously have posted about the situation. I would love to say my situation is an aberration but I greatly fear it isn’t particularly since 80% of all psych meds are prescribed by non psychiatrists. Needless to say, the situation is pretty disgusting.

      • Yes, AA, it was my PCP (who was paranoid of a non-existent malpractice suit) that initially put me on psychotropics, while claiming they were “safe … meds.” We already have a big problem with unethical and misinformed PCPs in this country.

        And Thomas Jefferson forewarned us of “the central banks, and corporations that will grow up around them,” 200 or so years ago. The pharmacutical industry is legally required, as a corporation, to behave like psychopaths for profit, so they do.

        https://m.youtube.com/watch?v=oOafbpaVw90

        The medical community needs to wake up the the reality their medical literature is tainted, stop trusting in psychopaths, and start trusting in their patients’ actual experiences again. They’ve already killed more patients with the psychiatric drugs in the past decade, if you take into consideration younger adults and children too, than the Nazi psychiatrists killed Jews, during WWII.

        https://www.rt.com/uk/258133-antidepressants-unnecessary-for-many/?

        Absolutely the situation is pretty disgusting.

        • There’s an eye catching link embedded in your rt.com article,

          READ MORE: Emotional toxicity of austerity eroding mental health, say 400 experts

          “The group of signatories, made up of therapists, psychotherapists and mental health experts, said Britain has seen a “radical shift” in the mental state of ordinary people since the coalition came to power.

          They warned people are plagued by increasing inequality and poverty as a result of the government’s austerity policies, and this reality is generating distress across the nation.”

          http://www.rt.com/uk/250501-austerity-toxic-mental-health/

          They’re destroying the people of England.

    • I believe that what goes around comes around. Karma. The people who knowingly and in accurately marketed Paxil are going to pay a price in this life or the next. Same with zyprexa. Same with risperdal. That is how life works in my humble opinion. The god I know sees everything.

    • Steroids are known to cause “bipolar,” too. Jane Pauly’s been advertising this completely iatrogenic pathway to a “bipolar” diagnosis, and psychiatry’s “meds for life” mantra for years now.

      http://ahrp.org/jane-pauley-from-steroids-to-mania-to-depression-to-bi-polar-to-drugs-for-life/

      And there are now millions researching and talking about the Federal Reserve and the “too big to fail” bankers’ historic and recent monetary crimes online, and there’s protesting going on in the streets, too. I’m not certain what percent of the population knows about their truly sordid history yet.

      But there is starting to be an information revolution, and if / when these war mongering banksters do try to pull off their NWO, I do see us likely heading into a WWIII, as do many others now. Despite the fact there is a peaceful solution, which God offered us long, long ago. Maybe the psychiatrists should get out of the business of defaming, poisoning, and torturing the ethical, intelligent, Christian American bank president’s children, for these evil bankers and their child molestation covering up minions?

  3. The end goal of Big Pharma: 99.9% of Americans diagnosed with a mental illness and taking medication. The 0.01%? Psychiatrists and their families. In this desired future, there have to be a few normal people left to treat the poor zombified masses.

    Seriously, this is pretty chilling. I can only feel disdain for the ignorant desk-bound government sheep writing these policy proposals. They likely know next to nothing about the long-term effects of psych drugs, the fraudulence of the DSM categories, or the psychological damage done by labeling people as incurably mentally ill. And this is what taxpayer money is paying for – for subjugation of the masses.

    This is funny: “”A common barrier to integrated care is a lack of knowledge and comfort with prescribing psychiatric medications.”

    It’s not that hard. You just pick a fake disorder from the DSM, and then roll the dice and choose a random medication to treat it. That’s what my psychiatrists used to do with me years ago. It’s so easy, a caveman could do it.

    (random thought – I wonder if there is a psychiatrist somewhere who actually rolls a 6-sided die to randomly choose what medication to give to his patients. I bet there is. And it would never come out as malpractice. Because unlike with physical medicine psych drugs don’t treat any known illness and the practice of prescribing them is exactly like rolling dice).

    • “And it would never come out as malpractice.”

      No, it would not, since the profession itself is malpractice or worse. The psychiatrists who are at legal and professional risk are the ones who abstain from drugging, thereby deviating from the norm or the community standard.

      However, I do not believe that most psychiatrists are smart enough to abstain from the drugs they are dispensing. Lieberman was sharp enough to protect his own son, but quite a few of them have inflicted this on themselves as well as their own children. The fact that this may be changing and also t that they are prescribing lesser doses is thanks to Whitaker and the movement he helped bring about, not the profession’s innate ability to reform.

  4. 65 million dollars.

    La Fitness membership per month $35

    65,000,000 / 35 = 1,857,142 / 12 = 154761 People could get a year membership even without a buy in bulk discount.

    Seriously if they want to improve population health target those people I see going into Seven Eleven that buy a “Big Bite” nasty ass hot dog and a “Big Gulp” of sugary soda or a sugar free soda full of phony ass chemicals and all the other stuff from the sugar, salt and cholesterol selection.

    You can just look at the people who waddle in and consume that garbage habitually and see how unhealthy they are.

    That behavior is the real “behavioral health” problem in this country doctors should be concerned about.

    And I think the people who buy the scratch offs to go with there sugar salt and cholesterol “meals” have mathematics disorder too, (315.1 impairment in mathematics) because I see so many people buying them and almost never see anyone win. Read the back of the ticket the odds of winning really suck.

    Lets see, every day you eat nasty food and loose money on scratch offs and never exercise, you are depressed have some Zoloft.

    I see the health care system has it all figured out.

    • “Seriously if they want to improve population health target those people I see going into Seven Eleven that buy a “Big Bite” nasty ass hot dog and a “Big Gulp” of sugary soda or a sugar free soda full of phony ass chemicals and all the other stuff from the sugar, salt and cholesterol selection.”

      That’s where lawmaking, politics and regulation comes into focus. People eat and drink garbage because it’s abundant and directly marketed (inescapable). To change the choices people make, the market needs to change. And that will mean that healthier choices need to be as affordable as garbage choices.

      The engineers of the world need to do much, much better.

  5. “…the proposal would entail a huge expansion of the psychiatric net, a diligent ferreting out, so to speak, of those “mentally ill people” young and old, who are “not being served,” and lots of additional jobs for psychiatrists.”

    Every time I think I have seen organized psychiatry hit rock bottom, I see something like.this. The creepy thing about this is that some people will be misled, thinking they are getting integrated, holistic care of the type offered by Dr. Brogan (relying on nutrition, nutrients, energy healing, etc.). Instead, as Phillip says, they will be swept up in the widening psychiatric, neurotoxic net, courtesy of their trusted (but clueless) family doctor. But in fairness, psychiatry could not pull this off without the complicity of government officials. Colorado should see its count of the mentally ill go way, way up…First, legalizing pot (Rocky Mountain High), now this. The state should be renamed Moron Territory, but the rest of America is not far behind.

  6. Psychiatry has a real problem given the high mortality rate among the people handed the most serious of diagnostic labels. Spin has laid the blame on disease and lifestyle, but we know that a great deal of the problem comes from psychiatric treatment, and especially from psychiatric treatment with neuroleptic and other drugs. It is, in other words, neither lifestyle nor disease that is killing people, it is the treatment. Integrated care draws in other medical specialists to deal with the problems created by psychiatrists. Yes, it represents an expansion of the system, but more than that, it amounts to an evasion of accountability on the part of psychiatry. Rather than stopping ineffective and damaging treatment programs, psychiatry is going to work more closely with medical doctors who will be treating the iatrogenic issues brought on by psychiatric treatment. There is not much good to be said about this further medicalization of the mental patient. With patients suffering from metabolic syndrome due to drugging with atypicals, you’ve got people suffering from obesity, heart conditions, diabetes, you name it, and you’ve also got a system treating this situation as if it were just a matter of course. It isn’t. Did we have effective non-damaging treatment programs this integrated care wouldn’t seem so necessary. It isn’t necessary. It’s the result of psychiatrists damaging their patients.

    Great post, and on a much needed subject, too. Why do people in mental health care need general practitioners so much? Because psychiatric treatment is so injurious. Now you’ve brought the medical profession on board to help cover up the crimes of psychiatry. As nobody in the system, given conflicts of interests, really wants to look at safe and effective methods of treatment, I’d say that’s a pretty easy thing to do.

    • I’m thinking about people I know whose medical treatment for chronic illness has been costly in terms of adverse effects of the drugs in combination with very little rapport building and patient teaching to encourage lifestyle changes, etc,. that would reduce the need for drugs. General medicine calls these patients, “train wrecks” and like their soon to be bed partner psychiatry, is looking for ways to blame the patient.

      The so-called big advancement in integrated care, is trolling for psych patients, no doubt, but it looks more like a win/win, in that GP’s can feel less guilty about not getting to know their *chronically ill* patients, and therefore having little impact on anything but throwing their drugs/treatments at the patients complaints– which, of course is not much help over the long term. Here again, the concept of magic bullets that can’t possibly cause harm, is shared by medical providers. The cornerstone of general medical practice looks no different than the one we know as the foundation for psychiatry. And the failures have to be accounted for– or rather, rationalized in a manner that clearly shows that it is something about the patient– he/she is very complex case, with co-morbid psych disorders complicating medical illness– blah, blah, blah, and so on.

      Bouncing patients back and forth– GPs and shrinks each making a buck as the evidence for treatment failure gets pinned squarely on the patient. And all of this results from the dehumanizing practices that health care has become — which I firmly believe was catalyzed by psychiatry’s boasting success, cashing in on RCTs in collusion w/ pharma–

      Since the early 90’s general medicine and psychiatry have been in a heated competition — over who can financially profit the most by pimping for pharma. Now it seems they are figuring out how to split the difference and each capitalize on the damage the other has caused.

      State of the art mind/body integrated health care? Yeah, that’s the ticket. The process for developing the marketing strategy is old hat, but we will only get a look at it if it ends up as evidence in a law suit that becomes accessible to the public, and is written up as another bit of corruption– perhaps destined to become the next nail biting scandal, serialized in the Huffington Post.

  7. Here’s what concerns me,

    “The overarching goal of Colorado SIM is to improve the health of Coloradans by providing access to integrated primary care and behavioral health services in coordinated community systems, with value-based payment structures, for 80 percent of state residents by 2019.”

    The overarching (correct) goal of Colorado SIM is to improve the health of Coloradans by providing access STOP.

    They aren’t providing anything to anybody. They’re building something and they need to support what they’re building. It’s highly likely that it isn’t going to be a voluntary system; it will be mandatory. That means there’s no real free will.

    If there were real, true, genuine “help” that would be nice but there isn’t any of that. There is institutionalization, in order to support system structures that ultimately exist to put paychecks in people’s pockets, more than it exists to truly help the majority of people it claims to “serve”. Oh, they’ll have their successes. But I doubt those success will outnumber the condemned souls (wards of the state).

  8. Treating the “worried well” is the ticket to making the billions of dollars.

    DSM – Diagnose as a Source of Money

    We say every emotion is a mental health problem, caused by a brain chemical imbalance.

    This is only our first meeting.

    Using little information, we are diagnosing you as mentally ill. Here is a prescription for some brain disabling drugs.

    You’re now locked into a life-time diagnosis, needing life-time psychiatric treatment.

    Meanwhile we get life time payments either from you or from your health insurance.

    We claim these brain-disabling drugs are “non addictive”, but good luck when you try to stop taking them and have evil withdrawals when your tired of life as a zombie and/or the dozens of side effects from the pills and try and stop taking them.

    We did this to you without any lab test, brain scan or any procedure known to medical science to show you in fact “have” an illness.

    We never get questioned by anyone. And, if the scam is found out, we have peers and attorneys to cover it up.

  9. It’s as if instead of being freely robbed and psychatropisized at will by the “authorities” in a nursing home in old age , in between singalongs and extended naps , the semi open air nursing home is being brought to us at the youngest age possible to obstruct any behavior that might be mistaken as signs of life . Are there really any large corporate enterprises that can for long even operate semi morally anymore ( if ever they did ) considering how they can be bought out and subverted further by those that actually or in effect print money at will ? Do not billions of people live under the now thinly disguised time released eugenic umbrella made up of hoaxed up pseudo science modality enterprises for profit affecting everything we need or use to sustain life?
    I was invited 2 years ago to a place that seemed different . For 2 weeks I stayed with relatives in Santa Barbara California . It was really laid back as if 9 /11 never happened with the the feeling somewhat of a 1960’s hippie beach low anxiety neighborhood . The organic farmers market was 6 blocks long . I bought a 30 pound bag of organic oranges for $10 . I didn’t see a police car for 2 weeks. I heard that in the winter the farmers market is only 2 blocks long . A couple houses down a 104 year old man had himself been fixing the roof of his house. But it is expensive to live there , even in a nearby town the cheapest studio apartment to rent is about $800 a month. I can’t afford it . I read on the internet that Denmark is a country that still cares about it’s population . I don’t know . But I do know psychiatry sucks, pharma as well ,our government as well . It may not hurt to have phony ID’s available to avoid the net . The rumor is there are pockets of sanity still left to go to but those may be like rumors of dry land in the movie “Water World” starring Kevin Costner. Best Wishes All . Keep up the stellar work Phillip . Thanks

  10. I think the term ‘ambush’ is correct. Pediatricians are ‘ambushing’ parents with facile questionnaires already. I think this is a bad idea because it erodes the trust relationship between parent and pediatrician. I may decline to fill out any such forms in the future, or say I need more time to answer them at home.