Integrated Behavioral Healthcare: Prospects, Issues, and Opportunities

There exists a conceptual and practical division between professionals that help people with physical/medical problems and those that help people with mental/behavioral problems. In this dualism, individuals with physical problems, like a broken bone, go to a medical doctor and individuals with behavioral problems, like a broken marriage, go to a mental health professional.

If all medical problems were due to physical causes and all mental problems were due to psychosocial causes, then diagnosis and treatment would be clear. However, this is not the case. Broken bones are caused by behavioral problems (e.g., marital abuse, alcoholism, poor diet). Medical problems are treated by behavioral changes (diet, exercise, and other lifestyle changes). And most medical treatments require, and can be defeated, by behavioral compliance problems with the prescribed regimen (pill taking, showing up for the scheduled procedures, etc.). Moreover, mental health problems can be caused and treated by physiological factors (neuron-chemical imbalances, endocrine problems, and psychotropic drugs). Thus, fragmenting the treatment of the mental and physical problems into two distinct realms makes little conceptual or practical sense.

Integrated Behavioral Healthcare describes the promise of integrating behavioral and medical care in the primary care setting - a move that recently has been gaining momentum. It provides a roadmap of the emerging directions integrated behavioral healthcare is taking and lays out the steps the mental health professional needs to take, in training and in modifying their clinical practice, to adapt to the new system of healthcare.

Nicholas A. Cummings, Ph.D., Sc.D. is the President of the Foundation for Behavioral Health and Chairman of the Nicholas & Dorothy Cummings Foundation, Inc. He was the founding CEO of American Biodyne (MedCo/Merck, then Merit, now Magellan Behavioral Care). He is also the former President of the American Psychological Association. Dr. Cummings was the founder of the four campuses of the California School of Professional Psychology, the National Academies of Practice, the American Managed Behavioral Healthcare Association, and the National Council of Professional Schools of Psychology. He was also the Chief Psychologist (Retired) at Kaiser Permanente. He was the former Executive Director of the Mental Research Institute. Currently, Dr. Cummings is a Distinguished Professor at the University of Nevada, Reno.

Janet L. Cummings, PsyD., is President of the Nicholas & Dorothy Cummings Foudation, Inc., and former staff psychologist at American Biodyne (MedCo, now Merit Behavorial Care). She earned her Doctorate at the School of Professional Psychology, Wright State University, 1992.

Victoria Follette is a professor of psychology and associate dean of Arts and Science at UNR who specializes in the treatment of trauma. Dr. Follette graduated from the University of Memphis and the University of Washington and is interested in the education of psychologists for the new millennium.

Steven C. Hayes is Nevada Foundation Professor and Chair of the Department of Psychology at the University of Nevada. An author of twenty books and more than 275 scientific articles, his career has focused on an analysis of the nature of human language and cognition and the application of this to the understanding and alleviation of human suffering. In 1992 he was listed by the Institute for Scientific Information as the 30th "highest impact" psychologist in the world during 1986-1990 based on the citation impact of his writings. Dr.Hayes has been President of Division 25 of the American Psychological Association, of the American Association of Applied and Preventive Psychology and of the Association for Advancement of Behavior Therapy. He was the first Secretary-Treasurer of the American Psychological Society, and is currently co-chair of the Practice Guidelines Coalition. This summer he received the Don F. Hake Award for Exemplary Contributions to Basic Behavioral Research and Its Applications from Division 25 of the American Psychological Association.

Dr. William O’Donohue is a licensed clinical psychologist and professor of clinical psychology at the University of Nevada, Reno. He obtained his B.S. in Psychology from University of Urbana-Champaign and his M.A. and Ph.D. in Clinical Psychology from SUNY at Stony Brook. Dr. O’Donohue’s research focuses on quality in mental health service delivery, integrated care, human sexuality, forensic psychology, cognitive behavioral therapy, and philosophy of psychology. For the last three decades, he has directed a free psychological treatment center for sexual assault victims. He has served on the American Psychiatric Association’s advisory committee to revise the diagnosis of pedophilia for the DSM5, and he has published more than 10 books with Elsevier, including Handbook of Cultural Competence in Applied Psychology and Forensic Interviews Regarding Child Sexual Abuse.