In a previous era, we drove past mysterious brick buildings, with long sweeping lawns and stately oak trees, housing the mentally ill for the state. Mental diseases were poorly understood by the community resulting from the isolation of patients to these stately institutions. Psychiatrists were also isolated from their community’s medical colleagues who gathered at the local hospital to care for the patients admitted with seemingly more objective medical and surgical disorders.
Clear minds eventually realized that “warehousing” people with mental health disorders was not necessary except for a small group of folks with severe and persistent mental illness. Community and regional hospitals accepted the challenge of opening beds for those patients that needed closer supervision on a temporary basis. This was the first step toward closer integration of mental disorders with other allopathic health needs. Nonetheless, patients are still segmented into disease conditions where mental disorders are often further compartmentalized and separated from other medical conditions that patients might suffer. A common example is the schizophrenic patient with concurrent diabetes ending up in the emergency room for ketoacidosis. While the diabetic problem is real, the root cause of the ketoacidosis was not the primary medical condition, but rather the fact that the unmanaged mental condition led to neglected medication causing the metabolic disorder.
We are entering a new era of health care where the hospital is no longer the center of the health care universe. Our objective is to keep people out of the hospital while improving their quality of life with better medical care at lower cost. The myths about mental disorders, especially schizophrenia, are gradually dissipating.Outpatient management of many mental health conditions is possible as well as being preferred.
The Accountable Care Organization (ACO), a community-based health care provider, is in an excellent position to lead in the inclusion of mental health care in the local population health management system. The fully engaged psychiatrist becomes as important to the care of this population as the cardiologist. It is also critically important that the primary care physician understand the elements of the common mental disorders as it is critically important that the psychiatrist understand and direct the management of the common physical disorders. After all, thoughtful writers in the late 19th century recognized that the human organism is clearly a single unit and as such demands an integrated approach to patient care.
Providers of all types need reliable data to measure progress and guide care through key performance indicators. The ACO data visualization and analytics tools such as Salient dashboards and Salient Interactive Miner are designed to track patients of all diagnosis types for the management of chronic diseases, emergency room utilization, inpatient care, and preventive measures. With appropriate administrative attention and clinical management, it should be possible to manage diabetes mellitus with the same attention to clinical detail as it is with a patient with a bipolar disorder with or without diabetes. This means that psychiatrists must be engaged in the care of the “whole” person, if not managing, then guiding the care with professional attention. Because the mental health of a given population is so important, providers of all types will say to all the mental health providers, “Welcome home! You are where you need to be as part of the community health care team.”