Why integrative care?
Improving access to health services is a priority across Canada. For many people with mental health and addiction problems, the fundamental challenge is not inadequate or uncoordinated care – it is gaining access to any care at all.
When Canadians seek mental health and addiction help, they typically choose the most accessible, non-stigmatized health care option – their family doctor. According to the World Health Organization, integrating mental health services into primary care is the most viable way of closing the treatment gap and ensuring that people get the care they need.
The Waterloo Wellington Local Health Integrated Network in Ontario produced the video Creating a More Seamless & Coordinated Healthcare Experience to show how integrating services can improve health outcomes. Simplifying the system so that people can find what they need when they are most vulnerable is fundamental. Integration is about service providers coming together to help people get the care they need in the easiest, most co-ordinated way possible.
Integrative care connects service providers and clients and families or other supports to deliver, manage and organize services related to diagnosis, treatment and care, recovery and health promotion. Integrative care is a means to improve services in terms of access, quality, client satisfaction and efficiency.
Integrative care for mental health and addiction clients reduces the number of stages in an appointment and the number of visits clients must make. Clients want continuity of care. They want health care experiences that are seamless, smooth and easy to navigate.
Integrative care is challenging and involves many levels. It is about aligning services and improving collaboration. In a health care culture based on differentiation, segmentation and silo mindsets, there is widespread support for integrating health and social care management for people with complex mental health and addiction issues.
Having one care plan and a multidisciplinary team responsible for primary and mental health and addiction care can address numerous health and social needs. For many clients, the integrated approach is the best way to improve their health, enhance their experiences and deliver cost-effective services. Integrative care is a demand-driven response to problems with access, fragmented services, system inefficiencies and high health care costs.
Principles of integrative care
Integrative care must benefit service users while adding value to the overall system. It involves building strong connections between health services, people and providers. Principles guiding integrative care include:
- being fully inclusive of all communities in the region
- responding to families and other caregivers, in addition to clients
- organizing comprehensive services across the care continuum
- planning processes with users and their families or other caregivers
- focusing on client-centred and recovery approaches to care
- maximizing client accessibility and minimizing duplication of services
- standardizing care delivery through interprofessional teams
- committing to service quality, evaluation and continuous care improvements
- creating information systems to collect, track and report activities
- providing organizational leadership and support
- delivering initiatives with a long-term focus
- engaging physician integration
- creating a strong governance structure that includes diverse stakeholders
- aligning funding with mechanisms to promote interprofessional teamwork and health promotion.
Collaboration across health, education, social care and criminal justice systems is increasingly becoming more vertically integrated. Organizations are learning to share knowledge and are using evidence-based guidelines from different levels of service. In order to provide affordable, high-quality health care, governments and organizations are collaborating and restructuring the health care system to:
- enhance efficiency and reduce fragmentation
- plan workforces based on the right skill mix in teams
- share public health approaches to prevention
- place more emphasis on equity and access outcomes
- regulate for effectiveness, equity and efficiency.
- client-centered care
- family-centred care
- recovery model.
British Association for Community Child Health. (2012). Position Statement: The Meaning of Integrated Care for Children and Families in the U.K. London, UK: Author.
Centre for Addiction and Mental Health. (2009). Submission to the Select Committee on Mental Health and Addictions. Toronto, ON: Author.
Grone, O. & Garcia-Barbero, M. (2001). Integrated care: A position paper on the WHO European Office for Integrated Health Care Services. International Journal of Integrated Care, 1(1), e21.
Ministry of Health (British Columbia). (2012). Integrated Models of Primary Care and Mental Health and Substance Use Care in the Community. Vancouver, BC: Author.
Rodner, R. (2009). All together now: A conceptual exploration of integrated care. Healthcare Quarterly, 13, 6–15.
Suter, E., Oelke, N., Adair, C. & Armitage, G. (2009). Ten key principles for successful health systems integration. Healthcare Quarterly, 13, 16–23.
World Health Organization & World Organization of Family Doctors. (2008). Integrating Mental Health into Primary Care: A Global Perspective. Geneva, Switzerland: Author.
- The Center for Integrated Health Solutions promotes the development of integrated health services to better address the needs of people with mental health and substance use issues in the United States. It is funded by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration.
Taking care to the streets: Shared care teams reach out to people who are homeless
by Anne Ptasznik
The cheery, yellow waiting room of the health care clinic at the Adelaide Resource Centre for Women, a city-run centre serving about 80 homeless women daily in downtown Toronto, has an eye chart, baskets of condoms, a folded-up wheelchair and a scale. A wall poster reminds women to get a Pap test. Women come here for health care and to get help with housing and life skills and to join social activities. There's no sign that this is also the office of a psychiatric outreach team.
The clinic is run by the Shared Care Clinical Outreach Service, which provides medical and mental health care for homeless people visiting shelters and drop-in centres at eight sites in the city. The service began in 1998 and is funded by the Ministry of Health and Long-Term Care, and run by the Centre for Addiction and Mental Health (CAMH) in partnership with St. Michael's Hospital and the University Health Network's Toronto Western Hospital.
The service works on a primary care support model through shared care teams. Each site has a full-time registered nurse and outreach worker; a salaried general practitioner visits one or twice a week, and a consulting psychiatrist visits regularly. In preparation for the doctor's visit, on-site team members engage and assess individuals who may need health care services. Read more