Doctor of Philosophy

dissertationThis publication examines the impact of integrating mental health into primary health care. Mental Health Integration (MHI) in Intermountain Healthcare (IH) has changed the culture of primary health care by standardizing a team-based care process that includes mental health as a normal part of the routine medical encounter. MHI sees mental illness through a new lens integrating mind and body and introduces a team approach that values both the patient and staff experiences. This multisite comparative study using qualitative techniques reports on health outcomes associated with MHI for patients and staff. Fifty-nine patients and 50 staff were interviewed to evaluate the impact of MHI on care for depression. Patients receiving MHI reported an improved relationship with caregivers (p <.001) and improved overall functioning in their lives. Patients valued responsive shared decision processes with team care givers (p <.0001) and coordinated follow-up plans (p <.05). Patients receiving care for depression via MHI were more likely to participate in treatment decisions, self-management, follow up care (p <.01) and lifestyle change (p <. 05) and desire to share lessons learned with others suffering from depression. Staff working in MHI clinics were more comfortable addressing mental health (p <.01) and had more time to spend with patients due to team support (p <.05). They defined MHI as an organized usual team process that empowered them to provide better care to patients (p < .001). As clinics became more committed to MHI staff viewed mental health as a normalized part of their practice (p <.01). Staff reported that the quality of the care provided had improved as a result of MHI (p <.01). Mental health problems rank second in chronic disease today. Normalizing mental health as an organized team process within the context of primary care offers promising results for improving outcomes and lowering costs. Using the patients' perceptions of the quality of care and its impact is timely focus for realigning health reform efforts towards patient-centered care