Integrated Care in Community Settings and Psychiatric Training.

Abstract

Integrated health care serves to strengthen resources and improve health outcomes for patient groups with complex needs. For example, in caring for patients with major mental disorders, community mental health services can be integrated with family practice, medical, surgical, and obstetric-gynecological services; psychiatric inpatient and emergency services; occupational and physical therapy services; and rehabilitative, housing, and employment services [1]. Integrated health care is necessarily a multifaceted interdisciplinary and interprofessional approach that aims to provide greater service accessibility, patient education, coordination, and quality of care [2]. Just as a variety of integrated clinical care models exist, each with varying degrees of interaction and sharing between disciplines, an array ofmodels also exist for educating psychiatry trainees to work in integrated mental health and primary care settings [3]. In this issue, we present six papers on the theme of integrated care, including three empirical reports, a review, an example curriculum, and a systematic review [4–9]. Recently, the American Psychiatric Association also published a task force report on integrated care [10]. Reardon et al. [4] surveyed program directors in general and child and adolescent psychiatry programs in order to evaluate residents’ education and experiences in integrated care. Although the response rates were low, a majority of respondents offered integrated care rotations and electives and fewer than half of responding programs provided didactic education on integrated care. Dube et al. [5] surveyed members of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) on how physical and behavioral health were integrated at their institutions. Although response rates were again low, behavioral health was most commonly taught in courses dealing with the practice of medicine, in neurology and in reproduction courses, and in family practice clinics. Ratzliff et al. [6] surveyed a convenience sample of psychiatrists who worked in integrated care settings and identified their perceptions of topics that were important for them and their integrated team members to learn about. McCarron et al. [7] present a longitudinal, clinically-based curriculum with an emphasis on providing preventive medical care for those with severe mental illnesses. Annamalai et al. [8] contend that psychiatry trainees should learn more general medicine in order to fill leadership roles in delivering integrated medical and psychiatric care in mental health settings. Coverdale et al. [9] performed a review of published programs in which partnerships have worked to better serve vulnerable, disadvantaged, and culturally diverse patient populations with major mental disorders by integrating psychiatric services with family planning, sexual health, and obstetricsgynecology services. The American Psychiatric Association task force report [10] describes the integrated care model, examines methods for teaching, and provides recommendations for promoting psychiatric education and training in integrated care. These publications each advocate for teaching on integrated care in concert with the provision of relevant clinical experiences. According to one of the articles in this issue [4], psychiatry trainees most commonly experienced integrated care as a traditional psychiatric consultation within primary care clinics. Fewer than 50 % of the responding programs provided * John H. Coverdale jhc@bcm.edu