Why Integrated Care?

A common concern
According to surveys done by the Centers for Disease Control, nearly one third of Americans report suffering some mental or emotional problem each month, including 10 percent who say their mental health was not good fourteen or more days a month. The prevalence rate among Medicaid enrollees may be even higher. Behavioral health issues affect a significant portion of North Carolinians – and our most vulnerable citizens are disproportionately affected.

Poor access to care
While some areas of North Carolina have high-quality providers of MH/DD/SA services, both public and private, these services are often not easily accessible, especially for our Medicaid and uninsured citizens. As reform of our public health system has evolved, some providers no longer bill for Medicaid while others who did have failed financially. In addition, MH/DD/SAS providers are not evenly distributed geographically — a fifth of North Carolina counties are designated as mental healthcare provider shortage areas.

In January 2006, a study by the Sheps Center reported that, between 1999 and 2004, nearly two-thirds of North Carolina’s counties experienced a decline in psychiatrist supply or had no psychiatrists. Increasingly, primary care providers (PCPs) are filling unmet behavioral health needs.

Poor coordination of care
Public behavioral health services are targeted at the most severely and persistently mentally ill and operate in a system that runs parallel and outside the general medical community. Although the general population often uses their primary care provider or the emergency department for acute care, PCPs are poorly equipped and uncomfortable screening for, diagnosing and managing many of the behavioral health problems that present to them. On the other hand, citizens who primarily seek care from MH/DD/SAS providers may have physical health care needs that go unfilled. Systems for referral between physical and behavioral healthcare professionals are cumbersome and there is little sharing of healthcare information.

Reattaching the head to the body
As services for mental health conditions developed, they evolved organizational and funding structures separate from traditional physical health services. Many have recognized the need to “reattach the head to the body”, but despite frequent calls for the integration of healthcare, significant barriers make this goal a challenge. The ICARE Partnership is committed to overcoming these barriers and creating a healthcare system that is Integrated, Collaborative, Accessible, Respectful, and Evidence-based. Additional information on integrated care is presented in “Trends in Children’s Mental Health: Public Health Implications” by Jane Meschan Foy, MD, and “Integrating Behavioral Health into Primary Care: The Experiences of an FQHC in Eastern North Carolina.”