In 2006, a groundbreaking report documented alarming facts about early mortality among people with serious mental illness, who die 25 years earlier than their fellow citizens. Six years later, the same organization that delivered this news has published a white paper that outlines steps toward a solution—the integration of behavioral health care and primary care. The new report by the National Association of State Mental Health Program Directors (NASMHPD) examines the role that state behavioral health agencies (SBHAs) can play in accelerating integration of care in the public system and provides several examples of innovative state programs to integrate care. Finally, the report also looks at Medicaid options that are available to states to design and finance delivery system changes to advance integration and collaborative care.

The report begins by pointing to the good news: a growing body of research and results from state initiatives demonstrate the value of integrating mental health, addiction, and primary care services—both in improving health of people with serious mental illness and controlling costs. An area of great promise is the reduction of risk factors for disease—lack of exercise, poor diet, and smoking—which are prevalent in this population. The bad news is that a complex mix of socioeconomic, health system, and clinical factors contribute to early mortality, and the chronicity of these problems suggests that narrowing the mortality gap will take time. However, some investigators have estimated how much it will cost to do nothing to reduce excess health care costs among patients with comorbid psychiatric and general medical disorders: $300 billion annually in the United States.

The report describes several evolving models of integrated care and the ways in which SBHAs in various states have implemented them. Key lessons learned from state efforts are summarized, along with the following action steps. SBHAs should work closely with Medicaid offices to ensure that behavioral health is included in health homes for all chronic conditions and to carefully evaluate the potential for health homes for individuals with serious mental illness. SBHAs should work with Medicaid officials and health care providers to establish the means and incentives necessary to integrate general medical and behavioral health services. SBHAs should consider collaborating with behavioral health providers or other entities in designing and testing new service delivery models. SBHAs should strongly support the continued investment in colocation of primary care services in behavioral health settings and the robust evaluation of these programs and their ability to improve health status, especially of those with serious mental illness.

The 42-page white paper, Reclaiming Lost Decades: The Role of State Behavioral Health Agencies in Accelerating the Integration of Behavioral Healthcare and Primary Care to Improve the Health of People With Serious Mental Illness, is the first in a planned series of 12 reports in NASMHPD's “Cornerstones for Behavioral Healthcare Resource Series,” which is designed to help SBHAs navigate the changing landscape of health care, provide background on key issues, and spotlight SBHA initiatives. It is available at www.nasmhpd.org/general_files/Publications/Integration%20Report_Final.pdf.