Integrated and collaborative models of care

Mental health and substance use disorders are leading causes of morbidity and disability around the world. Despite the existence of effective and affordable treatments for these disorders, the majority of those who need mental health care do not receive it, especially in low- and middle-income countries (LMICs) and rural areas of high-income countries, where a major barrier to effective mental health treatment is a critical shortage of mental health specialists. Embedding mental health specialists into general medical settings helps address limited access to scarce mental health resources by supporting primary care clinicians to provide mental health treatments. This type of health care delivery model, called integrated care, has been shown to have several advantages, including increasing access to care, enhancing quality of mental health care, creating more cost-effective care, and improving outcomes of comorbid physical conditions. In this chapter, the rationale and evidence for integrated care models from around the world is reviewed, with a focus on a highly coordinated integrated care model called collaborative care (CoCM). While the evidence base for CoCM from controlled trials is strong, research regarding facilitators and barriers to the implementation of CoCM in real-world settings is still growing as worldwide implementation efforts arise across diverse health care systems. This shift toward integrated care creates increasing demand for psychiatrists who are experienced in this model, and offers an outstanding opportunity for psychiatrists to leverage their skill set to reach large patient populations who currently do not have access to effective mental health care.