Rethinking the place of the psyche in health: toward the integration of health care systems.
OBJECTIVE
To review the value provided when health care systems independently manage medical and psychiatric care.


METHODS
The authors draw on data from the world literature, their own experiences and reflections (one author as an international consultant in the coordination of physical and behavioural health care), and input from colleagues throughout the world who face similar challenges to improve outcomes for complex, high cost patients in their own health care systems.


RESULTS
Most health care systems in the world approach the administration and delivery of mental health care separately from that of general medical care. This practice is no longer supported as effective, efficient or inexpensive. Rather accumulating data indicates that concurrent and coordinated medical and psychiatric care, which can only be accomplished by integrating physical and behavioural health through infrastructure change, should replace the present system of independently provided sequential care; that is, one which provides first medical and then psychiatric treatment, or vice versa, with little communication between clinicians in the two sectors.


CONCLUSIONS
By making mental health treatment an integral part of general medical care through reorganization of the funding system, a higher percentage of those now untreated for their psychiatric disorders, both within and outside of the medical setting, can have their mental health needs addressed in coordination with their physical disorders. At the same time, the number of patients that can be treated within the same budget will be expanded.
Kathol
Roger G
RG
Department of Psychiatry and Internal Medicine, University of Minnesota, Burnsville, Minneapolis, MN 55337, USA. roger-kathol@cartesiansolutions.com
Clarke
David
D
D001315:Australia; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics; D006801:Humans; D007388:Internal Medicine / Q000191:economics; D008329:Managed Care Programs / Q000191:economics; D001523:Mental Disorders / Q000191:economics / Q000628:therapy; D008605:Mental Health Services / Q000191:economics; D009313:National Health Programs / Q000191:economics; D010043:Outcome and Process Assessment, Health Care / Q000191:economics; D010348:Patient Care Team / Q000191:economics; D011570:Psychiatry / Q000191:economics; D011602:Psychophysiologic Disorders / Q000191:economics / Q000628:therapy; D012017:Referral and Consultation / Q000191:economics; D013001:Somatoform Disorders / Q000191:economics / Q000628:therapy