About 43.6 million or 18.1% of American adults were diagnosed with various mental illnesses in 2014 (NIMH, 2014). However, not everyone seeks or adheres to treatment, which is a prerequisite to mental health recovery given the chronicity of mental illness. Recovery is a particularly important goal in mental health nursing because it means empowering patients to achieve self-direction, better health, and wellness (US DHHS, 2016). In so doing, patients are enabled to attain their full potential. There is also a need to promote recovery through best practices that enhance care quality, increase treatment rates, and reduce inpatient care costs. The patient-centered medical home (PCMH) is a care delivery model that can promote recovery through regular, accessible, comprehensive, coordinated, and integrated primary medical and mental health care provided by a team (Baird et al., 2014). This paper summarizes and critiques the findings of a study comparing the impact of the PCMH on mental health recovery with that of services as usual.
Article Summary
Among Americans diagnosed with serious mental illness, only 58.7% reported receiving treatment (NIMH, 2014). Around 40.5% were treated in outpatient settings, 52.6% were on prescription medications, and 7.5% were in inpatient care (NIMH, 2014). These figures highlight the need to improve treatment prevalence with the goal of mental health recovery. While the PCMH is an evidence-based model, a prominent critique against it is the lack of integration of mental health care, a limitation which results in partial effectiveness (Baird et al., 2014). The topic of the article is significant in this respect as it generates evidence supporting the value of mental health care integration in a PCMH service model.
Sklar et al. (2015) investigated the effectiveness on mental health recovery of integrating the services of a mental health clinic and a primary care clinic within a PCMH framework. The authors highlighted how PCMH development was prompted by the prominent focus on acute illness and care quantity rather than quality. They emphasized the appropriateness of a chronic care perspective in primary care. They then described the participating clinics and the steps taken to achieve integrated administration and function. The difference between PCMH participants and service-as-usual participants was established. The article further discussed data collection, the study results, and data analysis.
Sklar et al. (2015) found that mental health integration in PCMH service delivery was comparable to service-as-usual in terms of effectiveness in promoting recovery specifically in the areas of goal-setting, illness knowledge, self-help, family involvement, and substance abuse. The authors also found preliminary evidence that the PCMH model can improve patient scores related to relapse, functional impairment, and hospitalization in a mental health unit better than service-as-usual.
The information from the article is useful in practice. With the consideration of mental health as equally important as physical health, it reinforces a holistic view of the patient in the fullest sense and also supports individualized care. It provides a rationale for learning to assess not only physical health but also behavioral health in the primary care setting and for the nurse’s role as coordinator in meeting patient-specific needs. The article further brings to fore the need to learn to collaborate with the patient, psychologist, psychiatrist, physician, and other members of the health care team and make integrated, patient-centered care planning, implementation, and evaluation a reality.
Article Critique
The strength of the study, as described in the article, is its design which is most likely experimental. Baseline mental health recovery measures and a control group were used for comparison and provided bases for judgments on effectiveness. The authors also employed 2 different but valid and reliable instruments and collected data from both clients and practitioners thereby increasing data accuracy and strengthening the findings (Polit & Beck, 2012). The chosen method for statistical analysis also revealed changes in outcomes over time rather than a single post-intervention measure enabling trends to be established. However, non-randomization is a major weakness and source of bias. The authors also did not determine the adequacy of the sample size via a power analysis (Polit & Beck, 2012).
Nevertheless, I will recommend the article to other colleagues because of the scarcity of research on PCMH and mental health recovery. The study significantly broadens the knowledge base on this topic especially among those serving primary care patients with a high prevalence of mental health illnesses. The study findings can guide collective efforts to bring about more holistic, patient-centered, and individualized care.
Conclusion
There is a high prevalence of mental illness but recovery is possible. The PCMH model facilitates integrated, comprehensive, and coordinated mental health and primary care from the chronic disease perspective. Based on a well-designed study, this model is equally effective as service-as-usual in improving measures of recovery and substance use but may be more effective in enhancing measures of illness management. The article promotes a holistic view of the patient wherein mental health and physical health are considered equally important. It also highlights multidisciplinary collaboration with the inclusion of mental health professionals and the need for nurses to also coordinate related services.
References
Baird, M., Blount, A., Brungardt, S., Dickinson, P., Dietrich, A., DeGruy, F. (2014). The development of joint principles: Integrating behavioral health care into the patient- centered medical home. Annals of Family Medicine, 12(2), 183-185. doi: 10.1370/afm.1634National Institute of Mental Health (NIMH) (2014). Any mental illness (AMI) among U.S. adults. Retrieved from https://www.nimh.nih.gov/health/statistics/prevalence/any- mental-illness-ami-among-us-adults.shtml
Polit, D.F., & Beck, C.T. (2012). Essentials of nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
Sklar, M., Aarons, G.A., O’Connell, M., Davidson, L., & Groessl, E.J. (2014). Mental health recovery in the patient-centered medical home. American Journal of Public Health, 105, 1926-1934. doi:10.2105/AJPH.2015.302683
US Department of Health and Human Services (DHHS) (2016). Recovery is possible. Retrieved from https://www.mentalhealth.gov/basics/recovery/
