Action is urgently needed. About one third of all adults in Germany suffer from mental health issues during the course of a year. Over the next few years, depression is set to become the most common chronic illness in Europe. If the pillared structure of the healthcare system already presents a major problem when treating physical diseases, then the fragmented system of general practice and specialized care, social services and nursing presents insurmountable obstacles for those concerned. Clearly, there is a pressing need for holistic, integrated and cost-effective forms of care.  

A positive example is offered by the Mental Health Integration (MHI) model developed by Intermountain Healthcare, the largest provider of healthcare services in the U.S. state of Utah. Brenda Reiss-Brennan, Mental Health Integration Director at Intermountain Healthcare, presented the concept last Monday in Berlin. In the context of a Lunchtime Forum, the International Network Health Policy and Reform brought together some 20 representatives from the worlds of politics, academic study and medical practice. General practitioners, psychiatrists, psychotherapists, health insurers, social service funding organizations and representatives of patients and their relatives discussed ways of improving care for persons suffering from mental health issues.

The Mental Health Integration Model

In its primary care clinics, Intermountain Healthcare has developed a three-stage approach. When a patient enters a clinic, the entire care team, from the desk officer to the head of clinic, automatically concern themselves not only with somatic complaints but also with the mental wellbeing of the person concerned. If the first-contact healthcare worker and the patient arrive at the conclusion that a mental health issue might be present, a questionnaire is used to determine the extent of the mental illness and the need for treatment.  

Treatment is administered in a cascade approach. Depending on the complexity of the condition, primary healthcare workers, mental healthcare managers, experts from a variety of specializations and above all the person affected and their family circle are involved in the treatment, which follows the principles of evidence-based medicine.   While the primary care workers (physicians or nurse practitioners) take care of the diagnosis and basic treatment of the patients, care managers (specially trained nurses) are responsible for the ensuing treatment of patients with complex treatment needs. The care managers liaise between and coordinate the activities of primary care, the specialized services provided by mental healthcare experts and the social and family environments. All staff at Intermountain Healthcare and all cooperating service providers are trained in the triage of patients with mental health issues.

Evaluations indicate a win-win situation

German private practice, on the other hand, has great difficulty in dealing with mental illnesses.  Professor Ulrich Hegerl of the University of Leipzig, who specializes in psychiatry and public health, expressed his concern that in general practice in Germany only every other instance of depression was correctly diagnosed and that of those illnesses diagnosed, only one in two were correctly treated.  

The initial results of MHI evaluations indicate a win-win situation; Intermountain's model has led to improved quality of care and a better quality of life. For the patients, the program improves their state of health and increases the degree of satisfaction, a fact from which the relatives also benefit. For service providers, the improved interdisciplinary cooperation reduces the pressure on them during the treatment of mental health patients. For the system as a whole, the program is an efficient one, since the costs are no higher than for regular care.

Integrated care requires a change of mind set

At the same time, the MHI program faces a number of challenges. An integrated treatment concept requires a change of mind set on the part of the service providers involved. Instead of considering physical health in isolation, it is important to take account of the interplay between mind and body, between the individual and society, claims Brenda Reiss-Brennan.  

How potential conflicts and the divergent interests of the various service providers can be overcome was also the subject of searching discussions among the German audience at the Lunchtime Forum. Although there are a number of promising projects throughout Germany in which innovative participants are cooperating at local level in order to optimize care for the mentally ill, no roll-out is currently taking place, even where good ideas are being put forward. In order to improve the situation of the mentally ill and their relatives on a national scale, greater political will and a concentrated effort on the part of the German healthcare system's self-governing structures would seem to be called for.