Integrate behavioral health with primary care

Modern Healthcare's recent series, “Channeling Choice,” asserted that “helping people change their behavior is the work of our century.” If this is true, behavioral-health providers have expertise that can help.

Psychotherapeutic innovations such as motivational interviewing and trauma-focused therapy have been shown to impact a wide range of health outcomes, but have had limited implementation in mainstream healthcare.

One reason might be stigma. More than half of Americans have emotional difficulties that affect their health, but it is more socially acceptable to see a football coach for counseling than a psychiatrist. Stigma has led to the marginalization of behavioral health, with treatment for depression (forecast to be the leading cause of disability worldwide) often segregated from the rest of healthcare by regulatory and reimbursement barriers.

Modern Healthcare's articles (Nov. 25, Dec. 2 and Dec. 9, 2013) highlighted the impact of health literacy on health behaviors. Two other approaches, motivational interviewing and trauma-informed care, address further barriers to change.

The first barrier is ambivalence—a normal reaction to change. Motivational interviewing helps individuals explore what they will gain or give up with every change, harnessing individuals' life goals and values as drivers of moment-to-moment change. Behavioral health has expertise in this form of therapy that can be readily shared. For example, emergency physicians and pediatricians trained to provide brief MI interventions have achieved results in reducing alcohol use and teen smoking.

Trauma, surprisingly pervasive in our communities, is another barrier to change. In a middle-class survey sample, the Adverse Childhood Experiences, or ACE, Study found that 22% of respondents were sexually abused and 66% of women experienced other traumas in childhood. The long-term effects of ACEs went well beyond mental health, increasing the likelihood of medical problems including cardiovascular and liver disease, diabetes and even early death. ACEs also increased unhealthy behaviors including smoking, substance use and sexual promiscuity—all maladaptive ways that people cope with trauma. What trauma-informed care helps people do is to explore the effects of trauma on their health and behavior, develop positive ways of coping and articulate their path to recovery.

Increased integration of behavioral health into primary care through provider training and care coordination will improve health outcomes, not only for those with mental illness, but for every person who struggles to change health behaviors. New, innovative partnerships are our path forward, and behavioral-health providers across the nation stand ready to help.

David Woodlock is president and CEO of the Institute for Community Living, a New York-based human services agency specializing in behavioral health.