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    Opportunity for Preventative Psychiatry

    Health Care Reform and Integrated Care Creates an Opportunity for Preventive Psychiatry

    ARLINGTON, Va. (December 3,2012) — Implementation of the Affordable Care Act (ACA) offers significant opportunities for improving prevention of mental illnesses and promotion of mental health according to members of the Prevention Committee of the Group for the Advancement of Psychiatry (GAP).  Writing in the December issue of Psychiatric Services, a journal of the American Psychiatric Association, the authors assert that the field of psychiatry is in a position to advance the goal of prevention of mental illnesses and to promote emotional and mental well-being.

    Ruth S. Shim, M.D., M.P.H. and coauthors describe the important role that psychiatrists can play in advancing prevention of mental illnesses, in particular by working to incorporate prevention strategies in integrated care initiatives and by collaborating with primary care providers to screen for risk factors and promote mental and emotional well-being.

    Provisions of the Affordable Care Act (ACA) will shift the U.S. health care system to address achieving wellness rather than just treating illness, including improved coverage of preventive services; incentives to integrate and coordinate primary care, mental health care, and addiction services; and establishment of the National Prevention, Health Promotion, and Public Health Council, which has developed a National Prevention Strategy

    Examples of potential primary care integration and prevention noted by Shim and colleagues include providing behavioral health screening such as with the nine-item Patient Health Questionnaire (PHQ-9) for depression or the screening, brief intervention, and referral to treatment (SBIRT) for substance abuse.  Further efforts might involve the use of mental wellness coaches and behavioral change experts inpatient-centered integrated care settings.

    The authors suggest that psychiatrists and primary care providers could collaborate on culturally and developmentally sensitive methods of screening for risk factors and adverse health behaviors such as substance abuse, domestic violence, and firearm ownership. In addition, by using a developmental perspective, psychiatrists could provide primary care-based interventions focused on enhancing strengths and protective factors among children, youth and their parents.

    While the Affordable Care Act offers opportunity, the authors recognize the extent of change and suggest a note of caution, saying that “Expanding psychiatric services to incorporate prevention within a primary care setting will require a paradigm shift that challenges the way psychiatry has historically been practiced.”

    The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis,treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at

    Erin Connors