Health care and health systems integration aims to ensure that behavioral health care services are more accessible and connected to the broader health care system.
SAMHSA works to ensure that behavioral health is consistently viewed and incorporated within the context of health promotion and health care delivery and financing. Through its grants, programs, data analysis, and policy activities, SAMHSA leads efforts to advance the recognition of behavioral health as essential to health, improve access to services, develop financing mechanisms to support positive client outcomes, and address costs.
The term “behavioral health” refers to the promotion of mental health, resilience, and well-being; the prevention and treatment of mental and substance use disorders; and the support of those who are in recovery from these conditions, along with their families and communities.
Behavioral health conditions and the behavioral health field have historically been financed, authorized, structured, researched, and regulated differently than other health conditions and fields. As we learn more about the physical impacts of traumatic experiences and behavioral health conditions, and the behavioral impacts of physical health conditions, SAMHSA understands the need to view behavioral health as any other health issue. As a consequence, changes will need to be made to systems, financing, laws, and structures to incorporate and respond appropriately to these new understandings.
The impact of untreated behavioral health conditions on individuals’ lives and the cost of health care delivery in the United States is staggering. SAMHSA data from its National Survey on Drug Use and Health (NSDUH) – 2013 indicates that people with mental illness are more likely to have chronic health conditions such as high blood pressure, asthma, diabetes, heart disease, and stroke than those without mental illness. And, those individuals are more likely to use costly hospitalization and emergency room treatment.
Similarly, people with physical health conditions such as asthma and diabetes report higher rates of substance use disorders and serious psychological distress. According to the Centers for Medicare & Medicare Services:
- 50% of Medicaid enrollees have a mental health diagnosis.
- People diagnosed with mental illness and common chronic health conditions have health care costs that are 75% higher than those without a mental health diagnosis; for individuals with a co-occurring mental or substance use disorder and common chronic condition, the cost is two to three times higher than what an average Medicaid enrollee pays for health care.
- For those with diabetes, the cost of treating this health condition is as much as four times higher when a co-occurring condition such as depression or alcohol addiction is untreated.
A recent review indicates that major mental health diagnoses are associated with death from 7 to 24 years earlier than for those without such disorders; substance use disorders also were associated with increased mortality.
Prevention, early detection, and treatment of behavioral health conditions must occur at the same time a person’s physical healthcare needs are addressed to achieve overall health and community health. Incorporating mental and emotional health development and promotion into community health and public health prevention strategies and activities can make all health promotion more effective and help prevent other public health issues such as teen pregnancy, community and interpersonal violence, tobacco use, and homelessness.
However, distinct and specialized care systems, financing structures, and training curricula continue to result in uncoordinated identification, diagnoses, and treatment of behavioral health and physical health conditions. Integration, as SAMHSA envisions it, extends beyond health (including primary, specialty, emergency, and rehabilitative care) and behavioral health care systems and recognizes that to treat an individual’s health and behavioral health also requires addressing their social needs, such as housing, employment, and transportation.