Integrated Care Refresh, Part 2: Reverse Integration of Care and Integrated Care in the Inpatient Setting

Published January 2022

The Psychiatric Services Editor’s Choice provides essential curated collections from recent issues of Psychiatric Services.  Each month, Editor Lisa Dixon and the Early Career Psychiatrist Advisory Committee offer a curated collection from the rich resource of articles published in the journal. Updates will focus on one area, summarizing for the researcher, clinician, and policy analyst the latest information and seminal research with links to specific content from Psychiatric Services.

This second installment of a double collection on Integrated Care focuses on models that strive to improve care and health outcomes for people with serious mental illness. Integration of behavioral health in primary care settings, highlighted in Part 1, most often focuses on the care of people with mild to moderate behavioral health problems. People with serious mental illness face glaring health disparities and decreased life expectancy, largely due to comorbid general medical conditions, and often primarily receive services in specialty mental health settings. Efforts to integrate behavioral health and general medical care for people with serious mental illness seek to address treatment barriers resulting from historically siloed health care systems and bring general medical care to behavioral health settings. These integrated strategies aim to improve access to care, strengthen communication and coordination between providers, and tailor services and build expertise in the care of people with general medical and psychiatric comorbidities.

In this collection, the first set of articles explores the reverse integration of medical care into behavioral health settings. Authors highlight behavioral health homes and other specialty mental health system–based integrated care models, including the incorporation of primary care and cardiometabolic screening into assertive community treatment. The second group of articles features integration of care in the inpatient setting. Authors describe integrated inpatient medical and psychiatric units, advocate for an evidence-based practice approach to evaluating medical-psychiatric units, and describe person-centered approaches to discharge planning for people with serious mental illness. Together, integrated behavioral health in primary care settings, reverse integration in behavioral health settings, and inpatient integrated care models for people with serious medical as well as psychiatric illnesses represent a continued movement toward more comprehensive, person-centered care with the goal to improve health outcomes and care delivery.

Please note that not all articles in this curated collection are available without a subscription. For access, learn about subscribing to Psychiatric Services.

Integrating Primary Care Into Assertive Community Treatment
Jeanie Tse, M.D., Jason E. Cheng, M.D., Edward Tabasky, M.D., Emily Kingman, L.C.S.W., Drew LaStella, Ph.D., Gertie Quitangon, M.D., David Woodlock, M.S.
Published online 9 Sept 2021

Improving Physical Health Among People With Serious Mental Illness: The Role of the Specialty Mental Health Sector
Emma E. McGinty, Ph.D., M.S., Rachel Presskreischer, M.S., Joshua Breslau, Ph.D., Sc.D., Jonathan D. Brown, Ph.D., M.H.S., Marisa Elena Domino, Ph.D., Benjamin G. Druss, M.D., M.P.H., Marcela Horvitz-Lennon, M.D., Karly A. Murphy, M.D., M.H.S., Harold Alan Pincus, M.D., Gail L. Daumit, M.D., M.H.S.
2021, Volume 72, Issue 11, pp. 1301–1310

A Continuum-Based Framework as a Practice Assessment Tool for Integration of General Health in Behavioral Health Care
Ekaterina Smali, M.P.A., M.P.H., Rachel M. Talley, M.D., Matthew L. Goldman, M.D., M.S., Harold Alan Pincus, M.D., David Woodlock, M.S., Henry Chung, M.D.
Epub ahead of print 24 Sept 2021

Assessing the Long-Term Effectiveness of a Behavioral Health Home for Adults With Bipolar and Psychotic Disorders
Karl Johnson, B.A., Miriam Tepper, M.D., H. Stephen Leff, Ph.D., Brian O. Mullin, B.A., Benjamin L. Cook, Ph.D., M.P.H., Ana M. Progovac, Ph.D.
2022, Volume 73, Issue 2, pp. 172–179

Randomized Trial of a Mobile Personal Health Record for Behavioral Health Homes
Benjamin G. Druss, M.D., M.P.H., Jianheng Li, M.B.B.S., M.P.H., Stephanie Tapscott, M.S.W., Cathy A. Lally, M.S.P.H.
2020, Volume 71, Issue 8, pp. 803–809

Association Between the Maryland Medicaid Behavioral Health Home Program and Cancer Screening in People With Serious Mental Illness
Karly A. Murphy, M.D., M.H.S., Gail L. Daumit, M.D., M.H.S., Sachini N. Bandara, Ph.D., Elizabeth M. Stone, M.S.P.H., Alene Kennedy-Hendricks, Ph.D., Elizabeth A. Stuart, Ph.D., Craig E. Pollack, M.D., M.H.S., Emma E. McGinty, Ph.D., M.S.
2020, Volume 71, Issue 6, pp. 608–611

Systematic Review of the Impact of Behavioral Health Homes on Cardiometabolic Risk Factors for Adults With Serious Mental Illness
Karen L. Fortuna, Ph.D., M.S.W., Peter R. DiMilia, M.P.H., Matthew C. Lohman, Ph.D., Brandi P. Cotton, Ph.D., Janet R. Cummings, Ph.D., Stephen J. Bartels, M.D., M.S., John A. Batsis, M.D., Sarah I. Pratt, Ph.D.
2020, Volume 71, Issue 1, pp. 57–74

Availability of Integrated Primary Care Services in Community Mental Health Care Settings
Jonathan D. Brown, Ph.D., M.H.S.
2019, Volume 70, Issue 6, pp. 499–502

Perspectives of Individuals With Serious Mental Illness on a Reverse–Colocated Care Model: A Qualitative Study
Rachel M. Talley, M.D., Stephanie A. Rolin, M.D., M.P.H., Barbara N. Trejo, Matthew L. Goldman, M.D., M.S., Jean-Marie E. Alves-Bradford, M.D., Lisa B. Dixon, M.D., M.P.H.
2019, Volume 70, Issue 9, pp 793–800

Organization and Outcomes of Integrated Inpatient Medical and Psychiatric Care Units: A Systematic Review
Maarten A. van Schijndel, M.D., Ph.D., Jeroen D. H. van Wijngaarden, Ph.D., Joris J. van de Klundert, Ph.D.
2021, Volume 73, Issue 1, pp. 64–76

Moving Beyond the Status Quo of Integrated Inpatient Medical and Psychiatric Care Units: The Path to Real-World Evaluation
C. Pinto, M.D., I. N. Fabbricotti, Ph.D., J. van Wijngaarden, Ph.D., W. J. G. Hoogendijk, M.D., Ph.D., J. Alsma, M.D., Ph.D., J. J. van Busschbach, M.Sc., Ph.D., M. A. van Schijndel, M.D., Ph.D.
Published online 27 Oct 2021

Taking the Long View in an Inpatient Medical Unit: A Person-Centered, Integrated Team Approach for Patients With Severe Mental Illnesses
Marsha N. Wittink, M.D., M.B.E., Wendi Cross, Ph.D., Jacqueline Goodman, M.A., Heather Jackson, R.N., M.S., Hochang B. Lee, M.D., Telva Olivares, M.D., Daniel D. Maeng, Ph.D., Eric D. Caine, M.D.
2020, Volume 71, Issue 9, pp. 885–892

Unmet Opportunity: Intensive Care Transition Intervention for Individuals With Serious Medical-Psychiatric Illnesses
Thomas E. Smith, M.D., Leslie A. Marino, M.D., M.P.H., Mark Olfson, M.D., M.P.H.
2021, Volume 72, Issue 7, pp. 856–858