Is Recovery a Dinosaur?Jun 13, 2012
Is recovery going the way of the dinosaur? Is recovery-transformation an old idea that should give way to more enlightened policies of integrated, co-located behavioral and physical healthcare services?
These days, I am hearing a lot about the integration of physical and behavioral health services. I am hearing about the co-location of physical healthcare services in behavioral healthcare centers. I am hearing about federally qualified healthcare centers and their capacity to serve those of us diagnosed with major mental disorders. I am hearing how, in some states, recovery has "fallen off the radar" and has been replaced with initiatives to support access to medical care and physical health services. A long-time advocate recently told me: "Recovery is old school. Today we are about integrated care."
I don't know about you, but the last time I was at my annual physical (April 2012), my primary care physician was anything but "integrated" and "whole health". I had the standard 20 minute physical exam that never once addressed my psychiatric disability. After my annual physical, I was in the reception area, getting my referrals for an annual mammogram, bone density and eye exam. Although a wall separated the medical reception area from the medical exam rooms, I heard a patient yell through the barrier, "And...I'll need my script for citalopram increased by 10 milligrams." To my astonishment I heard the muted physician's voice answer back through the wall..."OK". I found myself wondering, "So this is integrated health and behavioral healthcare?"
I don't think so. What makes us think that already-overburdened, over-worked primary care physicians will do a better job helping us recover? What makes us think that a primary care system, strapped with behavioral health clients, will do a better, more "wholistic" job of meeting our needs? I am worried that integrated health and behavioral health services will mean that psychiatric disability is placed squarely within the jurisdiction of physical medicine with its reductionistic, causal medical model. I am concerned that all we will be offered is psychiatric medication. I am concerned that when recovery is replaced with "integrated care", that symptom reduction will be the only focus of treatment.
What do you think? What are your concerns about the looming "integration" of behavioral and health services?