Cited by 231Mental Health Treatment and AccessPsychiatric care and mental health servicesPrimary Care and Health Outcomes

Closing the false divide: sustainable approaches to integrating mental health services into primary care

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Kroenke, Kurt, Unutzer, Jurgen·2017·Journal of General Internal Medicine

Abstract

Mental disorders account for 25% of all health-related disability worldwide. More patients receive treatment for mental disorders in the primary care sector than in the mental health specialty setting. However, brief visits, inadequate reimbursement, deficits in primary care provider (PCP) training, and competing demands often limit the capacity of the PCP to produce optimal outcomes in patients with common mental disorders. More than 80 randomized trials have shown the benefits of collaborative care (CC) models for improving outcomes of patients with depression and anxiety. Six key components of CC include a population-based approach, measurement-based care, treatment to target strategy, care management, supervision by a mental health professional (MHP), and brief psychological therapies. Multiple trials have also shown that CC for depression is equally or more cost-effective than many of the current treatments for medical disorders. Factors that may facilitate the implementation of CC include a more favorable alignment of medical and mental health services in accountable care organizations and patient-centered medical homes; greater use of telecare as well as automated outcome monitoring; identification of patients who might benefit most from CC; and systematic training of both PCPs and MHPs in integrated team-based care.

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Authors
Kroenke, K., & Unutzer, J.
Affiliations
Regenstrief Institute (US)
Corresponding author
Kroenke, Kurt
Venue
Journal of General Internal Medicine
Published
2017-02-27
Volume
32
Issue
4
Pages
404-410
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
OpenAlex
W2591581327
Cited by
231
References
61
Citations by year
2026: 17 · 2025: 13 · 2024: 19 · 2023: 31 · 2022: 32 · 2021: 53 · 2020: 23 · 2019: 16 · 2018: 15 · 2017: 12
FWCI
25.83
Type
journal article
Language
en
Open access
Locations
  • Journal of General Internal Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion, cc-by)
  • PMC
Funders
  • California Health Care Foundation
  • Society of General Internal Medicine
  • University of California, Davis
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
integrated mental health services, primary care, collaborative care, depression, anxiety, common mental disorders, measurement-based care, treat-to-target, care management, cost-effectiveness, accountable care organizations, patient-centered medical home, telecare, team-based care, implementation barriers
MeSH terms
Mental Disorders, Cost-Benefit Analysis, Humans, Mental Health Services, Primary Health Care, Models, Organizational, Delivery of Health Care, Integrated, Vulnerable Populations

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