Mental Health Services in General Health Care A Conference Report, Volume I (1979) / Chapter Skim
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V. An Integrated Summary of Invitational Workshop Discussions
V. An Integrated Summary of Invitational Workshop Discussions
Pages 121-138
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From page 121... ...
~ ,) ~ SECTION V AN INTEGRATED S _ Y OF INVITATIONAL WORKSHOP DISCUSSIONS Each conferee and observer participated in one of three workshop sessions on the second day of the conference.
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From page 123... ...
Difficulties with these distinctions seem to occur more frequently in the ambulatory primary care setting, where the relationship between mental health specialists and primary care practitioners is less clearly defined, than in the hospital, where the roles and functions of "liaison psychiatry" and general health care seem fairly well circumscribed.
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From page 124... ...
Several participants noted that -- with some exceptions -- complex cases and chronic mental illness requiring long-term care are best treated by mental health specialists. Thus, primary providers should be skilled at referring their patients, when diagnosis so indicates, to mental health specialists or to other social support systems.
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From page 125... ...
It was proposed that the basic mental health skills required by most general health care providers are relatively simple: warm, humane interests in the patient and the patient's problems, and a willingness to use psychotherapeutic and crisis intervention as well as pharmacological intervention to help people through acute crises. Beyond these basic skills, the general health care practitioner needs to obtain knowledge from social and behavioral sciences.
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From page 126... ...
Consultation or liaison psychiatry, in addition to promoting the improved management of a broad range of mental disorders can be a valuable means of continuing education for both general health care physicians and psychiatrists. The role of psychiatrists as educators in residency training programs may represent the current most effective linkage between psychiatry and the general health care sector, given the still relatively limited opportunities for direct collaboration in the actual delivery of care in established settings.
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From page 127... ...
It was suggested that perhaps the most important role of these social workers was a coordinative one between the health, mental health, and social service sectors. The participation of non-physician mental health specialists in general health care settings, both as primary care providers and as consultants, can encourage preventive health programs and patient involvement.
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From page 128... ...
offering more appropriate clinical training experiences to prepare medical students and residents for the practice of integrated health/mental health care; (3) providing appropriate and effective role models throughout the educational and training process; and (4)
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From page 129... ...
Several participants observed that, even when students are motivated to become providers of integrated health and mental health care, most training programs do not furnish adequate clinical preparation for the practice of mental health care in general health care settings. For most medical students who do not choose to specialize in psychiatry, practical experience in applying mental health skills under supervision is limited to the psychiatric rotation as a small and discrete part of their medical education, rather than as an ongoing process.
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From page 130... ...
It was suggested that role models must be sufficiently numerous to form a "critical mass" of professionals who believe in and can practice integrated care in order to demonstrate commitment to health/mental health linkages at all levels of care. Participants also emphasized the importance of engaging medical faculty with additional background in psychiatric skills, and psychiatrists and other mental health professionals who have experience working with nonpsychiatric physicians, in the training of primary care residents in mental health skills.
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From page 131... ...
Several participants expressed concern about inappropriate placements of both general care providers and mental health specialists, and urged that a variety of eligible service settings be considered by policymakers. REIMBURSEMENT Workshop participants registered a strong consensus that current patterns of financing do not support an optimal, integrated health/ mental health care system in this country.
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From page 132... ...
It was emphasized that lack of reimbursement deters the involvement both of psychiatrists and primary care practitioners in efforts to integrate health and mental health care. Although there increasingly is coverage for specialty care of mental health disorders by psychiatrists in private practice or specialty inpatient settings, there are minimal financial incentives for spending time in important consulting and ambulatory liaison psychiatry.
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From page 133... ...
(4) Grants to link primary care settings and federally-funded community mental health centers were mentioned as a means of tapping existing mental health care resources without, as one speaker put it, "worrying so much about the larger issue of third-party payments." Several participants suggested that studies be planned for future consequences of increased availability of reimbursement for mental health care in the general health care sector.
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From page 134... ...
For therapy, the patient's own closest social supports of family and friends often can work effectively with the care provider while such community resources as social agencies, churches, or schools can be involved to promote continued care. Although social support is clearly an important function of the physician - especially in integrated health and mental health care settings -- it was suggested that the problems of many patients may be managed as effectively or even more effectively by schools, welfare departments, clergymen, and other non-medical service systems.
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From page 135... ...
The point was made that other outside of the traditional health and mental health care systems also provide mental health services. In Virginia during 1977, for example, $3 million was spent under Title XX of the Social Security Act to fund mental health services in welfare departments, as compared with $500,000 in Title XIX funding for mental health services in mental health centers.
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From page 136... ...
to determine the incidence of mental illness. Many participants thought that extending treatment assessment from the specialty mental health sector to primary care practice will require all forms of health services research clinically-oriented, institutionally-oriented, and systemic studies.
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From page 137... ...
Evaluation research is need on training methods for primary care physicians who require modified forms of mental health specialty skills to provide appropriate mental health care. An example of this kind of study would be one in which "Balint" groups are evaluated as a training modality and as a mechanism for- improving provider satisfaction, particularly in settings such as HMOs or clinics, where there is considerable turnover of professional staff.
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