Unmet Patient Psychosocial Needs in American Healthcare: The Case for Integrating Behavioral Health, Social Services, and Primary Care

Unmet Patient Psychosocial Needs in American Healthcare:

The Case For Integrating Behavioral Health, Social Services, And Primary Care

Adrienne Swanson

California State University, Monterey Bay

Table of Contents

Page

1.Abstract ……….………...………………………………………………………………….…..3
2.Introduction ……….……………………………………………………………………….….4

2.1 Figure 1. Social Care Spending…...……………………….……….……………….4

3. Discussing the Causes of Unmet Patient Psychosocial Needs.…….………………………....5

3.1 Lack of Funding for Social Determinants ………………………………………....5

3.1.1 Figure 2. Determinants of Health ………………..………..……………...5

3.1.2 Figure 3. Healthcare Spending ………………..……………………...…..6

3.2 Poverty as a Cause for Unmet Patient Psychosocial Needs ...……….…………....7

3.3 Lack of Training and Communication Between Branches ………....………….....8

3.4 Lack of a Universal Health Care System …………………....….…...…………......8

4.Discussing the Effects of Unmet Patient Psychosocial Need in American Healthcare ….....8

4.1 Social Determinants and Unmet Psychosocial Factors ….………………………...8

4.2 The Effect of Poverty …….………………………………………………………...10

4.3 Effects of Lack of Training and Communication Between Branches …………..10

4.4 The Effect of America's Current Healthcare System ……………………………11

5. Discussing Solutions to Meet Patient’s Psychosocial Needs in the Primary Care Setting..12

5.1 Models for Integration ...…………………………………………………………...12

5.1.1 Bundled Payment Model ……………………….…………………….....12

            5.1.2 Disease Management Model …………………………….…...………….12

5.1.3 Fully Integrated Primary and Behavioral Health Model …………......13

5.1.4 Collaborative System of Care Model ……………….……………….....13

6. Conclusion ………………………….………………...…………………………………….....14

7. References ………………………………………………………………………………….....15

Abstract

The purpose of this research is to address the problems of the unmet psychosocial needs of the patient in American healthcare and patient health outcomes, to identify the primary causes, effects, and explore solutions both hypothetical, and tested.  This research paper includes: analyzing the current funding and role of social determinants and psychosocial factors; the role of poverty and insurance; the lack of training and communication between branches of primary, behavioral, and social service providers; the overreaching problems relating to America’s current healthcare system, and evaluating several possible solutions. This paper advocates for the collaboration and integration of behavioral health and social work into the primary care setting, and stresses the need for broad funding reallocation from primary care to include psychosocial health services.

Research Keywords: behavioral health, collaboration, healthcare, integration, psychosocial, social determinants, social work

Introduction

The United States of America is sick. We have been fighting this sickness for a long time, but we are starting to see it progressively worsen, and if not treated immediately we will fail. The symptoms are severe economic disparity, poverty, racism, heart disease, cancer, mental illness, substance abuse, hunger and homelessness. Morbidity prevalence is rising, and mortality rates that were once in decline due to advances in healthcare have risen for the first time in a decade (Centers for Disease Control and Prevention [CDC], 1999-2014). Tavernise (2016) explains the findings “show, a rate increase that was driven in part by more people dying from drug overdoses, suicide and Alzheimer’s disease. The death rate from heart disease, long in decline, edged up slightly” (p. A10). And as the lowest classes fall, the middle classes take their place, the threat no longer reserved for the poor.  

The United States is one of the wealthiest countries, and has the most expensive healthcare system in the world, yet America places dead last in terms of performance and health outcomes. How can this be? How are the other comparable countries outperforming us and spending less? The findings are astounding, one doesn’t need to look far to find the biggest disparity, every other comparable country spends roughly 2 to 1 on social services versus healthcare. America spends less than 60 cents to the dollar. This is a problem that reveals itself in every aspect of American life, this paper attempts to show how although healthcare as it is, cannot solve all that ails us. The unmet psychosocial needs of the people is the root of almost every symptom.

Health and Social Care Spending as a Percentage of GDP

[pic 1]

Figure 1. Social Services Spending. Reprinted from U.S. Health Care from a Global Perspective, by The Common Wealth Fund, 2015, retrieved from http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

This paper examines the need for collaborative social service spending at the primary care level by looking at the major causes of poor psychosocial health in Americans; determining the effects, and offers viable solutions for the national healthcare system. People are social creatures, we wither under the burden of stress and isolation causing a cascade effect on our health and productivity, leaving us unable to meet basic needs. It’s time to rethink our current care model of treating individual symptoms, and disregarding the impact of psychosocial factors on health.