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Psychiatry and Integrated CareFull Access

The Value of Collaborative Care

Published Online:https://doi.org/10.1176/appi.pn.2015.5b23

Abstract

Photo: Anna Ratzcliff, M.D., Ph.D.

Integrated care opens important new opportunities for psychiatrists to help improve the health of populations by partnering with primary care physicians and other health care professionals. This month, I have asked Anna Ratzliff, M.D., Ph.D., a psychiatric educator who is at the forefront of teaching integrated care skills to psychiatrists and other mental health providers to share her experiences. —Jürgen Unützer

After completing my psychiatry residency, I signed on to work as a collaborative care consulting psychiatrist at several local safety-net primary care clinics. Working as part of a collaborative care team, I learned new ways to leverage my psychiatric skills to support high-quality care of many more patients than I would have been able to help on my own. I have since become passionate about sharing the benefits and joys of working in collaborative care with other psychiatrists. The recent recommendations released by the APA Council on Medical Education and Lifelong Learning encourage a broad education in integrated care for all psychiatrists. As the associate director of education at the Advancing Integrated Mental Health Solutions (AIMS) Center, I spend much of my time thinking about how best to educate the next generation of psychiatrists as well as the existing psychiatry workforce about integrated care opportunities generally and collaborative care specifically.

WHY should psychiatrists learn about collaborative care?

The most compelling reason for all psychiatrists to learn about collaborative care is our professional commitment to our patients. While the United States has more practicing psychiatrists than any other country in the world, poor mental health continues to be a major public health issue that robs millions of people of their chance to lead healthy and productive lives, and fewer than 20 percent of those living with mental health problems see a psychiatrist in any given year. Collaborative care is a patient-centered, population-focused approach that can reach the large numbers of people suffering from mental illness who currently aren’t being treated by mental health professionals.

We will always need specialty mental health care. Collaborative care cannot and will not be suitable for all patients, but if more psychiatrists spend part of their clinical efforts supporting primary care providers, we could make a big impact for a large number of people. Collaborative care is particularly timely during this era of health care reform, and mental health specialists prepared to support a caseload of patients treated in primary care are valuable commodities. Even if you are never part of an integrated care team, you may treat a patient who received collaborative care and should know what that care looked like and be informed about this evidence-based treatment approach.

WHAT should psychiatrists learn about collaborative care?

Psychiatrists working in any type of practice may benefit from applying collaborative care principles, as these evidence-based practice guidelines have been proven to result in high-quality care and improved patient outcomes.

  • Population-based care: One of the important ideas taught in collaborative care is that you need to have a functional list, or registry, of all of your patients with mental health needs so that none of the patients who need help “falls through the cracks.” Proactively reaching out to patients on a caseload who need help, are not following up, or are not improving drives the improved outcomes of all patients in care.

  • Treatment-to-target care: Many psychiatrists are familiar with validated patient-rated screeners and patient-rated outcome measures. In collaborative care, you optimize the use of these measures to adjust your clinical care to achieve patient goals. Regularly monitoring a patient’s progress in a systematic way and changing treatment if the patient isn’t getting better is a practice applicable to any clinical setting.

  • Patient-centered collaboration: Collaborative care provides a structure for effective collaboration between a patient’s providers. This could be as simple as knowing what other providers are involved in a patient’s care to working on a fully integrated team with structured communication.

  • Evidence-based treatment: Collaborative care supports the consistent application of evidence-based medication approaches and behavioral interventions, whether as a part of a collaborative care team or not, and the ability to make evidence-based recommendations to other team members.

  • Accountable care: A commitment to setting outcome goals for the care provided and evaluating whether those goals are met for both the individual patient and for the entire patient panel can be guiding principles in any psychiatric practice.

HOW can I move toward collaborative care?

Psychiatrists can support and incorporate the collaborative care approach in a number of different ways and on a number of different levels.

  • Shaping care for patients: For most psychiatrists, applying the collaborative care principles can help you provide optimal care for your patients. Start small by identifying one principle you would like to incorporate, and then make the necessary practice change to support it. To become more skilled, explore continuing education offered through the Integrated Care Track at APA’s annual meeting and the new interactive APA online continuing education program, “Applying the Integrated Care Approach,” that will become available on the APA website this summer.

  • Shaping care for a population: If you’re interested in being a collaborative care psychiatrist, look for opportunities to practice population-based mental health care. Many collaborations start with reaching out to primary care practitioners in a local community.

  • Shaping the future of psychiatry: Encourage medical students, residents, and other trainees to learn about integrated care and to pursue career paths that can impact mental health at a population level. Learn about the different training programs that teach integrated care and steer interested early career psychiatrists toward them. These new ways of practicing require large system changes, especially the way that psychiatrists are paid. Psychiatrists interested in advancing collaborative care should support APA’s efforts to advocate for payment reform that covers collaborative care.

As consumers, payers, and regulators increasingly demand evidence-based mental health services, psychiatrists need to be prepared. Our field is in an exciting time and poised to make a tremendous contribution to public health. As a psychiatrist and a teacher, I am hopeful about the opportunities for all psychiatrists to support the health of populations through collaborative care approaches. ■

APA members can access the report “Training Psychiatrists for Integrated Behavioral Health Care” here.

Anna Ratzliff, M.D, Ph.D., is the associate director for education at the University of Washington AIMS (Advancing Integrated Mental Health Solutions) Center. Jürgen Unützer, M.D., M.P.H., is an internationally recognized psychiatrist and health services researcher. He is a professor and chair of psychiatry and behavioral sciences at the University of Washington School of Medicine, where he directs the Division of Integrated Care and Public Health and the AIMS Center, dedicated to “advancing integrated mental health solutions.”