A Rhonda Hamilton Policy Position Statement on Mental Health:

Rhonda Hamilton believes that treating the whole person through the integration of behavioral health and general medical healthcare can save lives, reduce negative health outcomes, facilitate quality care, and promote efficiency and cost savings.

Behavioral health has historically been authorized, structured, researched, financed and regulated differently than general healthcare, and mental health and substance use disorders have been treated both separately from each other and separately from primary care. This historical separation is now generally understood to have been counter-productive to achieving person-centered, comprehensive health goals. Body and mind are inseparable, interdependent, and interactive, and scientific evidence supports the foundational principle of Mental Health advocacy: “There is no health without mental health.”

Integrated care can be a promising practice to deal with the fragmentation of the DC healthcare system through a team approach. By bringing behavioral health clinicians into general medical settings – especially primary care, and adding general medical care to behavioral health treatment, better outcomes can be achieved at lower cost.

Consistent with the principle of integration, every child, adult, and family should receive mental health and substance use prevention, early identification, treatment, and long-term support regardless of how and where the person enters the healthcare system. To accomplish this, integration needs to be dramatically increased at the clinical, operational, financial, and policy levels. For example, current patterns of screening for depression are not consistent with making health care more patient-centered, efficient, or effective. Improving identification and treatment of depression in primary care is unlikely to change without better integration of mental health services. Payment and other policies that separate mental health from physical health should be changed to better accommodate care for depression in primary care. Under the Hamilton administration we believe that integration must eventually involve the entire treatment community and include the full continuum of general health, mental health and substance use treatment services. Providers on both sides of the behavioral and general healthcare interface should receive full and timely information and should follow evidence-based protocols, informed by team practice, in order to identify all of the potential interacting conditions and treatments and treat the whole person.

Eventually, integration will need to go beyond clinical settings, and engage all relevant stakeholders in the community in the promotion of behavioral health.

The Implementation of Integrated Care:

Integration between behavioral and general healthcare requires both increasing primary care providers’ capacity to address behavioral health conditions and increasing coordination between primary care and behavioral health providers. Two examples of evidence-based approaches to increasing primary care providers’ capacity to address behavioral health needs are the Collaborative Care Model and the COPE program. The Collaborative Care Model uses behavioral health clinicians as consultants – the primary care provider confers with the behavioral health clinician for advice, but the behavioral health clinician does not necessarily ever meet with each individual face-to-face. Instead, the primary care provider offers evidence-based therapies, medications, and supports through their practice. With the COPE program, a nurse practitioner is trained to deliver a short-course of cognitive-behavioral therapy from within a primary care practice. These two models can work together, and both represent ways of increasing primary care’s capacity to meet behavioral health needs directly. While there are many more examples of how behavioral health can be integrated into primary care, it is critical to design a DC care model based on a careful assessment of the needs of the surrounding community.

The other approach is to better coordinate primary care and behavioral health providers. As behavioral health integration has become more and more of a priority, the demand has increased to collect, analyze, synthesize, and issue actionable information about integration initiatives that providers, policymakers, investigators, and consumers can readily use and apply.

Definition of Integration:

The care that results from a practice team of primary care and behavioral health clinicians, working together with patients and families, using a systematic and cost-effective approach to provide patient-centered care for a defined population. This care may address mental health and substance abuse conditions, health behaviors (including their contribution to chronic medical illnesses), life stressors and crises, stress-related physical symptoms, and ineffective patterns of health care utilization.

This Definition Requires, in Particular:

A practice team tailored to the needs of each patient in order to create a patient-centered care experience and a broad range of outcomes (clinical, functional, quality of life, and fiscal), patient-by-patient, that no one provider and patient are likely to achieve on their own. With a panel of clinical patients in common, behavioral health and medical team members together take responsibility for the same shared mission and accountability for total health outcomes. Using a systematic clinical approach, (and system that enables it to function) involving patients, caregiver, and clinicians in decision-making to create an integrated care plan appropriate to patient needs, values and preferences.

Barriers To Integrated Care:

The current healthcare system inadequately addresses both sides of the behavioral and general healthcare interface. Barriers such as high caseloads, the burden of billing and documentation, issues with electronic health records and data sharing, lack of financial compensation, lack of education about and familiarity with evidence-based practice, and lack of available time make it difficult for primary health care systems to implement effective behavioral healthcare treatment strategies. Unfortunately, primary care providers often cannot afford the time, and thus commonly fail to recognize or treat substance use or mental health conditions. Behavioral health providers suffer some of the same problems in diagnosing and treating general medical conditions. The responsibility for providing mental health care continues to fall disproportionately on primary care. While psychiatric professionals are an essential element of the total health care continuum, the majority of patients with mental health issues will continue to access the health care system through primary care physicians. The desire of patients to receive treatment from their primary care physicians, or at least to have their primary care physicians more involved in their care has been repeatedly documented. Improving mental health treatment requires enhancing the ability of the primary care physician to treat and be appropriately paid for that care. Payment mechanisms should recognize the importance of the primary care physician in the treatment of mental illness as well as the significant issues of comorbidity that require non-psychiatric care.

Supporting Integration Into Primary Care:

Identifying strategies to reduce the barriers faced by primary care physicians should be a priority since most people in recovery prefer to receive their mental health care within a primary care setting. The role of primary care identification and treatment of mental health conditions is also particularly important for special populations including older adults and low-income populations of color that are likely to go undiagnosed.

The health home concept and the use of a team approach to treat behavioral and general health conditions show great promise, and integrated healthcare systems enhance the role that social support services and psychosocial treatment play in the recovery process.

Integration has demonstrated an improved health status in people in recovery and improved ability of physicians to manage mental health conditions, such as by reduction of emergency room visits. Accumulating evidence supports the effectiveness of some approaches for providing behavioral health care through pediatric primary care. A comprehensive pediatric medical home model that includes behavioral health care has the potential to optimize the availability, quality, benefits, and cost- effectiveness of behavioral health services. Integrated programs such as the chronic care nursing model are effective and cost-efficient for improving the treatment of depression in long term care. Changing the culture of healthcare presents great challenges. Integration, while continuing to show promise, is slow to be implemented in practice. The reasons for this go back to the historical divide between mental health and general healthcare. Substantial organizational and financial barriers persist, and sustainable integrated care programs are still the exception rather than the rule. Health IT remains a mostly undocumented though promising tool. No payment system has been subjected to large scale experiment, and no evidence exists as to which payment mechanisms may be most effective in supporting integrated care.

Call To Action:

Under the Hamilton administration our Mental Health focus is dedicated to supporting DC’s efforts to integrate behavioral and general health care and continued efforts to improve the quality of mental health and substance use services available in primary health care settings as well as the quality of primary health care services available in specialty mental health care settings. Additionally, DC needs an overall overhauling of its current Mental Health Services. We need higher and also stricter standards, accountability, and most of all core services with employees who understand DC residents’ culture. Our goal is to foster the broad implementation of available research and models in real-world health delivery systems, and to eliminate the clinical, financial, policy and organizational barriers to the integration of mental and general health care.

I am Rhonda Hamilton, and I am running for
DC Mayor 2022.

Do you want change or more of the same?

#IAMDC!

On November 8, 2022, Write-In Rhonda Hamilton, Independent because when it comes to Mental Health, there is no party affiliation only humanity. 

(Check our website daily for updates, and for exciting news from DC Mayor Candidate, Rhonda Hamilton.)