For years, the prevailing notion in medicine held that the body is treated in a physician's office and the mind in a separate mental health facility.

That view is slowly changing, however, as a growing number of medical professionals and others contend that such separation leads to ineffective treatment that does not answer patients' needs.

"When you take mental health out of primary care, you get poor outcomes and you pay more for it," said Benjamin Miller, Psy.D., director of the Eugene S. Farley Jr. Health Policy Center, an initiative of the Department of Family Medicine at the University of Colorado Denver School of Medicine. The majority of patients who are diagnosed with mental illness are initially seen and treated in a primary care setting, he noted.

Miller spoke during a recent forum hosted by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, "From Fragmentation to Integration: A Triple Aim Imperative." During the event, panelists addressed how the notion that a patient's mental health can be separated from his or her physical health is an outdated one.

Unfortunately, said Miller, the majority of patients who receive a referral from their primary care physician to a mental health specialist do not make the visit. He suggested that one reason for the lack of follow-up is the unwillingness of patients to describe their mental health to another professional with whom they are not familiar after having already detailed their concerns to a physician they trust.

"People are saying, 'When I go for primary care, I want my mental health needs to be addressed there," said Miller.

Parinda Khatri, Ph.D., chief clinical officer at Cherokee Health Systems, a comprehensive community health care organization with 56 clinical sites in 13 counties in Tennessee, recalled a woman who recently visited a clinic after her son died in an accident. The day after the accident, the woman went to see her primary care physician to discuss her situation. If she had instead tried to make an appointment with a therapist, she might have faced a six-week waiting period.

"We need to be on the path that patients have decided to walk," said Khatri.

According to Miller, policymakers and private insurers have sufficient reason to combine mental and physical health care because there is a market incentive to reduce overall costs and a public health mandate to improve patient outcomes.

Still, those in the general population don't place a premium on taking care of their own health, Khatri observed, perhaps because they don't receive strong enough encouragement to do so.

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Speakers Emphasize Need to Integrate Primary, Mental Health Care