Coordinating Care for Better Mental, Substance Use, and General Health

Benjamin G. Druss MD, MPHJune 26, 2006

Two Issues Central to the Committee’s Work and Findings

• Mental, substance-use, and general health conditions commonly run together

•However there is separation across the systems

that treat them and fragmentation within them.

Overarching Recommendation

Health care for general, mental, and substance-use problems and illnesses must be delivered with an understanding of the inherent interactions between the mind/brain and the rest of the body.

Some Key Terms

•Collaboration: Communication, shared understanding of goals, shared decision making

•Care Coordination: The outcome of effective collaboration

•Communication: Clinicians share needed information with other providers

Finding A Balance

• Communication: Information Sharing vs. Privacy

•Coordination: Centralization vs. Specialization

• Collaboration: Shared vs. individual accountability

(1) formal agreements

(2) case management

(3) collocation

(4) coordinated practices of primary and M/SU care providers.

A Continuum of Coordination

Less coordination

More coordination

Organizations should seek to move towards greater coordination between MH/SU and primary care:

Who Needs to Be Involved

•Clinicians and Health Plans

•Purchasers

•Accreditation agencies

•Federal and state governments

Bottom Line

• Need to foster improved communication, with an eye towards protecting patient privacy

•Need to foster improved collaboration and coordination, while retaining MH/SU expertise

•Need to identify someone who is accountable,while also recognizing we all are accountable