On resiste a l’invasion des armies, on ne resiste pas l’invasion des idees [An invasion of armies can be resisted, but not an idea whose time has come].
Victor Hugo (Histoire d’un Crime, 1852)
I feel fortunate to have lived long enough to see the “integration model” of health care taking hold! Or have I? Or has it? In a world that seems at times to be coming apart, it is heartening to see the words “integration” and “collaboration” in such prolific use. Can we be hopeful in what it portends for general and mental health?
The idea of integrated care did not magically emerge, but has a rather tortuous history, an accretion of many iterations over decades, if not centuries. It has struggled against barriers that have resisted the seemingly natural impulse to retain mind and body as a unified entity, joisting at times with religious, philosophical, political, economic, and inter- and intra-professional oppositions.
What is integrated care anyway?
Integration is a word with so many meanings as well as functional applications that one can never be certain what it refers to. It ranges from civil rights advances, to electronic circuits, to economies, to institutions and their various components, to the components of living organisms.
In psychiatry, it most often refers to some adumbration of efforts to link aspects of mind and body, perhaps best illustrated by consultation-liaison psychiatry. But words like “integration” and “collaboration” are probably better understood than “consultation-liaison” psychiatry.
In today’s world with its health focus, we see it applied fundamentally in 3 ways:
1. Clinically, related to mind-body interaction and holistic medicine
2. Disciplinarily, with alliances between programs and services
3. Institutionally, involving coordination with administration, finances, data, records, mergers, and so on
Clinically, endeavors to reunite psychiatry with medicine have arguably shown greatest sustainability in the special field of consultation-liaison psychiatry. Evidence has been manifest in the very foundations of consultation-liaison psychiatry, in psychosomatic medicine, general hospital psychiatry departments, inpatient milieu programs, med-psych units, double boarding, biopsychosocial medicine, and behavioral medicine.1
Dr. Lipsitt is Professor of Psychiatry (part time), Harvard Medical School, Cambridge, MA.
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