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Richard C. Brown
English 1010-53
Irene Petersen
18APR2016
The Current State of Integrated Health Care
Introduction
In 2012, I applied to company that helped patients with an array of health
and mental issues that would come to Community Bridges, INC. of Arizona, for
services that were sought by anybody who really needed help and assistance. The
facility that was assigned as a work station built its patient care motto Detox
comes with Integrity at the entrance of the main detox facility. When first starting
with CBI, it was an entry position of an Intake Technician and its responsibilities was
to look oversee incoming patients that were seeking detox treatment, which had
requirements for the detox program, mental health care, and coordinating care with
patient who needed assists with housing and/or medical clearance from the leading
medical licensed professional; the RN. While working for CBI, talking to patients as
well as adapting to the addiction lifestyle and atmosphere that came to the facility,
it became an eye opener of how Integrated Healthcare has incorporated with
Primary Health Care, Mental Health Care and Behavioral Health Care have actually
meshed well. Continuing with a higher education for an RN degree, the question has
resurfaced, Does Integrated Care with Mental Health Care and Primary Care still
work?
Crowley, Ryan A., BSJ and Kirschner, Neil., PhD. The Integration of Care for Mental
Health, Substance Abuse, and Other Behavioral Health Conditions into Primary are:
Executive Summary of an American College of Physicians Position Paper. Annals of

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Internal Medicine. American College

of Physicians. 28 APR 2015. Web. 11 APR

2016.
Summary: The Position paper entry by Ryan A, Crowley of The Integration of Care
for Mental Health, Substance Abuse, and Other Behavioral Health Conditions into
Primary are: Executive Summary of an American College of Physicians Position
Paper, is a condensed study on Mental Health and Primary Care that focus the
definitions of Mental/Behavioral Health Care and its degrees of Integrated Health
Care with different types and levels patient care. The essays approach to Patient
Care is to define the term Mental illness which is in unisom with the CDC [defined by
the CDC, medical conditions that disrupt a persons thinking, feeling, mood, ability
to relate to others, and daily functioning], it is supported by static findings
provided [one source] SAMSHA on subjected findings based on substance abuse and
mental health disorders where as the primary health care aspect is relates in a
parallel with its findings and agrees with correlative general health issues such as
diabetes, cardio/pulmonary vascular diseases, to immunodeficiency disease or
neurological diseases/disabilities are relatable to depression, sedentary lifestyles,
eating disorders, and suicide.
Analysis: The article is very in depth with the stance on Mental Health Care,
Behavioral Health Care, and Primary Health Care. Although it does realize its
fallacies with the current Health Care system in place, it does outline the Affordable
Care Act as being a key component to use for acquired services that were not able
to be access due to Medicaid or Medicare. It also defines Behavioral health as an
entity itself due to underlining addictions, addiction, and sedentary lifestyles. The
article points out a variety of statistics that supports general health diseases. An
example of this statement is patients who have a mental illness are more likely to

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develop of having Hypertension [High Blood Pressure], Cardiovascular [Heart]
Disease, Diabetes, Over Weight issues, and COPD that have a chronic illness. The
Authors also point out that having a chronic illness is likely to be costly with a
mental illness, whether its pre-existing conditions or an acute, onset symptom(s).
They also argue that the levels of integration of care has its stages of screening,
diagnosis, brief treatment, and referral to additional primary care if needed with
using appropriate measures of practiced methods of treatment. The main
understanding of their definition of Patient Care is The concept of providing whole
person, comprehensive care is rooted in the definition of primary care and with
that understanding, the scope of practice in the Integrated Care model is supported
by various organizations such as WHO, SAMSHA, and AHRQ. The authors have made
the model apparent with patients, especially with Behavioral Health Issues, going to
the Hospital for Primary Care services is a point of care which is an opening to
provide mental health care in a general medical setting. Although, it is realized
that physician tend to under diagnosis certain mental behavioral to by prescribed
with anti-depressants. With an outline of issues that is pointed out such as
Treatment Access (patient not able to access medical care due health coverage,
lack of transportation, treatment cost, and so on), Information Exchange
(Information to be forward without patient consent versus HIPPA law), The Stigma of
behavioral health treatment, and Workforce issues (stating that health care
professionals equate to mentally ill patient, low wages, high turnover rates, an out
of date field, and an unequal distribution of work.). As the article continues with the
levels of Integration services (Coordinated Care, Co-located Care, and Integrated
care) Integrated care is described as behavioral and physical health clinicians act
together to design and implement a unified patient care plan. This model often

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connotes involving social and other services., which provides a statistic section of
Evidence for Effectiveness of Integration which addresses an overall positive
effect to medical, mental, and behavioral professions that is positive through the
community. Although, as the model have its limitations due to resources and scope
of practice, it shows it is consistent of the whole person concept that becomes a
fundamental element of primary care.
Assessment: The article is a Position paper to anyone of considering the variables
of Health Care in general. It informs the reader of what is to be excepted with
statistics that arrive to a Hospital via Emergency Room to specialty fields of Primary
Care (i.e. Cardiology, Neurology, and so on) Mental Health and or Behavioral Health
fields in the evolving medical field. It gives you an understanding that patient with a
mental or behavioral disorder is now treatable at Emergency Rooms or Clinics at the
Hospital. With prior experience, it is easy to relate with Integrated Health Care
model and how the model is a good practice.
Currid, Thomas J., at el, Mental health issues in Primary care: implementing
policies in practice. British Journal of Community Nursing. 17: 1 21-26. Mark Allen
Publishing Ltd
Summary: The written entry by Thomas J Currid, Anna Turner, Nevys Bellefontaine,
and Marcanonio M Spada takes a look at Integrated Health Care model that is
practiced in the United Kingdom (London) and realizes that medical field and
services have switch its focus from medical specialty to mental health care in the
primary care setting. It states that mental illness will become the second most
common case for patients to check-in to a primary care facility as well as the
projected mental illness of depression in 2020 will be one of the leading factors of

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short life span among adults. The approach to mental health care in a primary care
setting is the impact of pre-existing condition that patient has, the abilities and
assisting aids of able to cope with chronic or acute illness, Support groups and
programs, and the complications of the illness itself with medical treatment that
effects to the mental health of the patient. As the Entry continues to
evolving/updating policies, proactive strategies, services to Integrated Health
System, and the Stigmas of Mental Health patients and professionals.
Analysis: This an interesting point of view from an outside source like the United
Kingdom that is also under taking the Integrated Care model for its patients and
professionals. Although, the relating social issues of the U.K. can be somewhat
relatable, it definitely has a parallelism with the US and its approach to Mental
Health Care only with Integrated Care. With London Medical insight thats right
beside with Western Medicine, it is also easy to transition from statistical findings of
general health aliments, to professional and patients suffering a negative stigma
with Mental Health Care itself, and impacting roles on on-coming RNs and Physician
in their respected fields. Thomas J. Currid is a Senior Lecturer in Mental Health,
London South Bank University. Anna Turner is Practice Experience Facilitator for
North East London Community Services Havering, St. George Hosptial, Hornchurch.
Nevys Bellefontaine is Practice Experience Facilitator for North East London
Community Services, Marcantonio. Marcantnio M Spada is a Professor of
Psychological Therapies, London South Bank University, London.
Assessment: Outlining the positives and negatives of the Integration Health Care
approach, its very understanding that the Great Britain is having relating issues
compared to the United States of America Heath Care System. Although, it is very
similar to the previous written entries on Integrated Health Care, the positive

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attitude towards the nurses role and position in the practicing health care model is
a focal point to incorporate the improvement to the delivery of Health Care services
with Mental, Behavioral, Primary Care services. To work in collaboration with other
medical professionals, the overall goal is to the continuing care through education
and skills of assessment, competence, interventions, monitoring the effects of
medication, prevention, information on psychotherapy, and outpatient services, it is
to reflect the positive actions to the medical professions at any levels of care due to
its positive outcomes to the patients. Its main focus is on the cause and effect of
current subjects on economic, social, and medical issues that is the U.K.
Ramsay, Wayne, J.D. The Myth of Psychiatric Diagnosis (2014). 1-17. Web. 26 ARP
2016
Summary: Wayne Ramsays argues the stand on the Psychiatric Medical field as a
pseudo-science and is below the justice system. What is apparent with the entry is
the opening statement which is in a form of a quote by Fredric Neuman, M.D., It is
always possible to make a psychiatric diagnosis on everyone but argues that the
term diagnosis is misinterpreted and misused by physicians that used on patient
who state that there is nothing wrong with them (a claim that their state of mind is
sane at corresponding facilities). The author argues that as a society among other
people, to be labeled with a psychiatric diagnosis has a huge impact of how a
person is treated and is damaging to the livelihood of persons life. He quotes of
several Doctors that in the related field of psychology/psychiatry, states that a
disband on the Psychiatric field is a to be a joke and unscientific. The author also
uses examples of an experiment that has been conducted to point out inaccurate
diagnosis with the use of pseudo-patients at The Blackwell Island Insane Asylum in
New York (based on a book that is titled Ten Days of Madness). Ramsays use the

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authors first-hand experience/account on Early American Mental Health practices in
the 1900s. The written entry also uses the DSM (The Diagnostic and Statistical
Manual of Mental Disorders which is provided by the American Psychiatric
Association) is misguide and inaccurate by renaming the DSM book with a political
corrected title like Mental Disorders Descriptions Manual versus DSM. Overall, the
author compares the DSM to Malleus Maleficarum (the Witch-Hunt Manuals) and has
labeled the Psychiatry field as Witch-Craft.
Analysis: The Author is clearly on a one-side argument of the Mental Health aspect
as a threat to its patients. The written entry is biased and uses several doctors that
claim psychiatry as a pseudoscience by discrediting the diagnosis notion for
disorders or syndromes of its given definitions, the physicians ability to decipher
sane patients to insane patient, and gives examples of the disorder entries in the
DSM as a very negative to Psychiatry and Mental Health Care as a whole. Although,
the author does note that there is a difference of physical ailments that contribute
to mental disorders and illness by using medical specialties such as Cardiologist for
Cardio/pulmonary diseases to Neurologist and the study of dementia that relates to
a biological evidence of chronic disease, it does point out that there are differences
between Mental Health and Primary Care with point of view at jurisdiction position.
Wayne Ramsay, J.D. is an attorney for the Law Project for Psychiatric Rights (17),
who advocates for patients who have been labeled with a psychiatric diagnosis on
case to case basis in the Justice System via courts.
Assessment: The written entry really questions the stance on Mental Health issue
with the Psychiatric field by debunking the notion of Psychiatry is not a Medical
study or a profession. He does have pros that support his claim to of Psychiatry is a
Myth or Ruse, yet appeals to be more of a one-sided argument and has one-

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dimension opinion to support his argument with quotes and citations from Doctors
along with their books. The author does stir a lot of emotions to anybody who is the
practicing medical field, especially Psychiatrist. Denouncing the DSM as a reliable
source of labeled diagnosis and disorders by using common disorders such as
sleeping disorder (compares a normal citizen sleep schedule to a Doctor working at
night and not sleep during the day instead of the night is a disorder), Gambling
addiction (which this is a Behavioral issue and disorder), to Voyeurism (a sexuality
issue). Yet the biggest emotional stir up is using rape as a psychological disorder
and states that it was consider to a disorder in the DSM. Although, he says that rape
is a crime and assume that the APA didnt want to label the criminal action as a
diagnosis, it successfully questions the credibility of the Mental Health Field as a
whole. Overall, it questions the reliability by having no validity, therefore no
relevant or accurate findings of diagnosis of a mental disorder or illness.
Satel, Sally and Torrey, E. Fuller. A Prescription for Mental-Health Policy. National
Affairs. Spring 2016.

3-22. Print.

Summary: In the Essay of Satel and Torrey, it opens with an example that starts
with current events on public shootings which points to the clinical rhetorical appeal
of the current state of mental health care and the US as a country. It discussion the
issue of Mental Health Care and Primary Care with its policy that have been
established via United States government. The authors have outlined the current
state of Mental Health Care by going back to the past that leads up to the present
day along with its current policies. It also points at the Mental Health Care and
Primary Care is the solution to an array of patient care, the model they relate is to
whole body care versus the common primary care silos (a one size fits all motto).
Overall, the essay is focus on the service to provide Mental Care versus prescribing

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medication to the vast major that often generalizes diagnosis to be easily under
diagnosis or misrepresented. Therefore, not treating the real cause of Mental
Health/Behavioral Health issue that Americans face on a daily basis.
Analysis: The essay is well versed with the take on the Health Care System in
General and outline its pros and cons on Integrated Care system. The main
example is given by the year of the 1950s Health Care System, the developing
plans of Medicare and Medicaid (both are different and have been determine by its
defining by-laws as well as how they are used) that became active, to the
deinstitutionalizing of Mental Health Care and its hospitals (Psychiatric Wards, State
Hospitals, Asylums) by re-writing laws and policies that reduced funds for mentally
ill patients and delocalize the community with no preparation of how to counteract
with Mental or Behavioral episodes. The authors also use current issues that have
been apparent to the present day from public shootings to substance abuse that
have been increasing with every passing decade. With inappropriate mental health
care at prisons to non-monitored, continuing care that requires monitoring, mental
health patient that have been diagnosis with a severe mental illness [SMI], this
shows that the US health system has not assisted correctly with Public Health. The
current health system points out the inaccuracies and the inabilities of mental
disorders its self and along with medical professionals. [The authors have
determined that mental health as a whole is very distinctive due to the different
types of treatment ranging from serve mental illness treatment, i.e. Schizophrenia
or Bi-polar disorder, compared to common mental illness, i.e. depression, eating
disorders, ADD, ADHDand so on]. The essay goes on about the stigma of Mental
Health Care, from patients to professionals, that resulted to Political
Empowerment [the term has evolved to consumer-survivor] which is provided by

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activist against Psychiatrist torture or brutal medical procedures that have been
long disband [the organization that supports the group is through SAMSHA, yet it
shows that SAMSHA has looked at both sides of the spectrum of Mental Health Care,
but do support the Integrated Health Care model that is discussed throughout the
essay]. Although the issues of mental health care having a vast array of cons, the
authors do focus on patient assessment of paternalism which is the mind set of not
acknowledging of having a problem to begin with. As Satel and Torrey states, Such
people are too lost in their psychosis to show up for a focus group or to embrace the
recovery agenda. Indeed, approximately half of all untreated people with a
psychotic disorder do not acknowledge they are ill, which is itself a neurological
condition called anosognosia. (11) . As more issues come up; re-vamping Medicaid,
more training and education to law enforcement/medical professionals, and use the
maximum federal and state programs that each state is elected to the policyholders, Satel and Torrey conclude with the right reforms to the current health care
system, it can increase patient care with people who suffer severe mental
disorders/illness and be able to improve with quality of life. Sally Satel, a
psychiatrist and a resident scholar at the American Enterprise Institute (3), and E.
Fuller Torrey, a psychiatrist and a founding member of the Treatment Advocacy
Center, a non-profit working to eliminate barriers to treatment for people with
severe mental illness (3), their credentials speaks from themselves.
Assessment: The Essay is proposed to an audience that work in the Health Care,
Mental Care, and Behavioral Care field. Its emphasis is that the current health care
system, which is not be the best system there is, but theres certainly ways to get
help as well as professional welling to help with any type of disabilities or disorders
to assist patients with the correct and long lasting treatment to produce a

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productive life. This was definitely an eye opener with the negative activism of
consumer-survivor which is not a helping factor when an organization that seeks
out for Integrated Health yet back lashes its common practices in the psychiatric
field that is detrimental for mental health care. The position of this essay is to be
informed of the current Health Care system and what could be the root of unrationalized violence that occurs in America.
Stevens, Lawrence, J.D. Why Psychiatry Should Be Abolished as a Medical
Specialty (2001). 1-8. Web.

26ARP2016

Summary: The main focus of the written article by Lawrence Stevens is what the
title entails to abolish Psychiatry as a Medical Specialty. As the author states that
Psychiatry should be abolish due to the fact that medical school education is not
needed any more and is referred as psychotherapy and that the understanding of
Mental Illness as a biological disease due to chronic illness is an error by the means
as a cure-based treatment versus psychotherapy counseling (i.e. electro-shock
therapy) does more damage the good. The author also argues the biological
approach to a mental illness/disorder as the main cause is misleading and has also
said So-called mental or emotional illness are caused by unfortunate life
experience not biology. There is no biological basis for the concept of mental or
emotional illness, despite speculative theories you may hear. The brain is an organ
of the body, and no doubt it can have a disease, but nothing we think of today as
mental illness has been traced to a brain disease.
Analysis: Stevens claims that medical education, does nothing towards to their
understanding and treatment when it comes to psychology and its patients with
mental disorders/illness in general primary care. The authors take on the subject is

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relatively negative towards doctors as well as psychiatrist and its medical specialty.
Although, the author uses examples to compare and contrast by giving the job to
the wrong labor (the represented problem of cigarette commercials and to removing
the TV program is giving the TV repair to do the job) is a fallacy. Even though the
author has disapproved the medical field/study of Psychiatry, he expresses his
opinion in a biased response. Lawrence Stevens, J.D., a lawyer that represents its
cliental: psychiatric patients.
Assessment: Stevens take on the Mental health that is relatable to a biological
cause is answered by a fact to fact and straight forward answers that are a standard
until it is disproven by scientific studies. The author may have disavowed Psychiatry
but not psychology which is interesting because both field of studies is the study of
human emotion and to understand human behavioral with a scientific appeal. He
uses Sigmund Freud as an example in a Primary Care setting while Freud is in his
residency at the time. The biggest persuasion to the argument is the use of Dr. E.
Fuller Torrey and his book Death of Psychiatry. The approach to this entry is very
logic based and it not only questions your understanding of Mental Health care but
Psych-psychology as well.
Unzicker, Rae. To Be a Mental Patient (1984). Web. 26 APR 2016.
Summary: A poem entry that reflects the thoughts and effects as mental health
patient in the United States Health Care system and it speaks in volumes with
simple reflections as a mental patient with first hand expression with the mental
health stigma by society.
Analysis: It is very appealing to the emotion of understanding the mental health
patient of having no control with your own life, always monitored by everyone, and

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labeled to a negative diagnosis such as paranoia. It is also an interesting note on
how the patient is taking an interest of finical contrast on the patient is on
government assists whereas the Doctor is driving a Mercedes Benz. Although, there
is no credentials to the author, but according to NARPA.org, Rae Uznzicker was an
activist for civil rights for with people with psychiatric disabilities for 20 years.
Assessment: The poem is a great example of understanding what a mentally ill
patient goes through on their daily life under the Health Care System in the US.
Whether you can relate to the authors struggle, you certainly can see the utter
defeat that makes you feel paranoid and frustration with the provided services that
is in current use at Health Care facilities for Mental or Behavioral Health services. It
shows how the Stigma of Mental Health Care really is self-demeaning for the person
who is going through the struggle.
Conclusion
The topic of Integrate Health Care model as a productive service to the
patients that are seeking health also provides a positive feedback to the offered
services that is supported by the state and medical institution. But, the mental
health aspect of care and treatment still under goes a certain amount of criticism as
well as negative feedback from lawyers and patient that have experienced the
social stigmas of Mental Health Care. While continuing my education to pursue the
RN degree, it really inspires to look at the Health Care System and its policies as a
whole and not letting out the negatives and the positives what patients
expectations to providing excellent or horrible Health Care.
Works Cited

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Crowley, Ryan, BSJ and Kirschner, Neil, PhD., The integration of Care for Mental
Health, Substance Abuse, and other Behavioral Health Conditions into Primary
Care: Executive Summary of an

American College of Physicians Position

Paper. Annals of Internal Medicine.


Currid, Thomas J., at el, Mental health issues in Primary care: implementing
policies in practice. British Journal of Community Nursing. 17: 1 21-26. Mark Allen
Publishing Ltd
Ramsay, Wayne, J.D. The Myth of Psychiatric Diagnosis (2014). 1-17. Web. 26 ARP
2016
Satel, Sally and Torrey, E. Fuller., A prescription of Mental-Health Policy., National
Affairs. 27: Spring

2016 3-22. Ingram Periodicals, INC., 2016., Print.

Stevens, Lawrence, J.D. Why Psychiatry Should Be Abolished as a Medical


Specialty (2001). 1-8. Web.

26ARP2016

Unzicker, Rae. To Be a Mental Patient (1984). Web. 26 APR 2016.