The Train is Leaving the Station: Is Psychology Aboard?

Abstract

This special issue of the Journal of Clinical Psychology in Medical Settings (JCPMS) considers integrated care between psychology and primary care. This is not an altogether new subject, as individual journal papers and a range of books discussing aspects of the subject have been published for years. Strong advocates underscoring the importance of providing effective mental health services in primary care settings, such as Nicholas Cummings, William O’Donohue, Kirk Strosahl, Patricia Robinson, Andrew Pomerantz and Alexander Blount, have been trying to wake up the psychology community for years to the dilemmas created by two silos of health care. Despite previous writings on the subject we think this issue is unique for two reasons. The first is, the collection of papers represents a deconstruction of the construct of integrated care into its essential elements and then each paper addresses the key issues, such as clinical, operational, administrative, financial, training and research aspects to integrated care. The second, taken as a whole, the special issue explores whether psychology will play a meaningful role in the now rapid emergence of integrated care and we hope gives a call to action. The importance of integrated care has been increasingly embraced in the health care system. Whether a willingness to align psychology closer with medicine is growing within psychology is an open question, but psychology has made some contributions. Championing psychological treatments of medical patients, the American Psychological Association was instrumental in the American Medical Association’s adoption of the Health and Behavior codes and Medicare reimbursement of these codes nationally. However, despite Medicare adoption of these codes, acceptance of the codes by other financial pay sources has been unequal and providing a convincing argument to financial entities to do so has been left to individual practitioners efforts at the local coverage levels (Kessler, 2008). There are multiple systematic reviews each concluding, with limitations, that collaborative primary care is effective. Such initiatives have been undertaken by such organizations as the Cochrane Collaboration and most recently the Agency for Health Care Research and Quality (Gilbody, Whitty, Grimshaw, & Thomas, 2003; Butler et al., 2008). The Substance Abuse Mental Health Services Administration (SAMHSA) in partnership with the Health Resources and Services Administration (HRSA) recently authored a publication entitled Integration of Mental Health/Substance Abuse and Primary Care advocating the financing of behavioral health in primary care and outlining a set of recommendations for doing so (Butler et al., 2008). Even more recently the World Health Organization published its 2008 World Report (http://www.who.int/whr/ 2008/en/) entitled Primary Health Care––Now More Than Ever, a call for collaborative primary care across the world. Since 2003 SAMHSA has been funding a grant program entitled Screening, Brief Intervention, Referral and Treatment SBIRT (http://sbirt.samhsa.gov/) each grant being 10? million dollars over 5 years, to provide substance use and identification services within primary care and other settings. In an economic climate in which meeting attendance is in retreat, there is an annual meeting of the R. Kessler (&) Department of Family Medicine, and the Center for Translational Science, University of Vermont College of Medicine, 371 Pearl Street Burlington, Burlington, VT 05401, USA e-mail: Rodger.Kessler@UVM.edu