 Healing Body AND Mind: A Critical Issue for Health Care Reform
Roger G. Kathol, M.D. & Suzanne Gatteau
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Book Reviews
Bruce M. Kelly, Director of Government Relations, (Mayo Clin
Proc. November 2007;82(11):1435)
Type and Scope of Book: An analysis of the relationship of physical
and mental health, focusing on how the current health care system
fails to integrate the two and the resulting negative effects on
quality and cost of care. The book also offers a vision for an
integrated system that should be a component of any meaningful
health care reform.
Contents: The book combines a clinical approach to the relationship
of body and mind, a critique of how this relationship is generally
ignored in the current US health care system to the detriment of
patients, and a vision for an integrated care delivery model that
could provide better results for patients at a lower total cost.
Through the use of case vignettes and “what-if” scenarios,
the authors shine much-needed light on the dysfunctional system
that fails to deal with patients who have both physical and mental
health issues. The book also offers a model of patient- centered
integrated care that could greatly improve out- comes for patients
and reduce health care costs.
Strengths: The book is readable for a lay audience, primarily
because of the use of informative clinical vignettes to make the
analytical points real. It rightly points to several major problems
with our health care system: the failure to provide the integrated
care that patients really need and the way we have constructed
a system that acts as a major impediment to doing the right thing
for the patient.
Deficiencies: Perhaps the authors should have expanded the scope
of analysis to make the case that lack of integrated care is also
a major problem within the realm of physical health, with silos
of specialists who provide disintegrated care to the detriment
of their patients.
Recommended Readership: All health care professionals and anyone
concerned with reforming our health care system. In particular,
the book should be enlightening to students and trainees who are
about to enter this dysfunctional system.
Overall Grading: Five Star (outstanding)
Thomas N. Wise, M.D. (Psychosomatics 48:456-457, September-October 2007)
Dr. Roger Kathol’s professional career has been dedicated
to integrating psychiatry and medicine. He is a leader in developing
education for those pursuing certification in both psychiatry and
internal medicine, also advocating for growth in the medical-psychiatric
unit. At present, psychiatric care is separated from the rest of
medical service by managed-care approaches. This leads to fragmentation
and inefficient care. This easily-readable book documents this
separation and demonstrates how to integrate the two disciplines.
The authors provide a historical overview of the history of psychiatry
that may have abetted such fragmentation. Sadly, the "managed-care
revolution" reified the partition of "behavioral health," as
it is termed in the book, from the rest of general-medical healthcare.
Behavioral managed-care organizations are financially separate,
both in accounting and managed psychiatric care, from the general
medical-surgical insurance system. The book clearly documents how
such a system works. One of the great advantages of this volume
is that it outlines and defines the various approaches to managed
care, with a particular focus on behavioral health. The chapter
called "Mangled Medicine" reviews the current funding
of healthcare (15% of the gross domestic product of the United
States), for which we get a flawed product.
The remainder of the book offers solutions for the current "physical
and behavioral health illness disconnect." Dr. Kathol provides
both a rationale and model for a truly integrated healthcare approach.
The cost savings of early identification and evidence-based treatment
of psychiatric and substance-abuse problems is well documented.
He then goes on to demonstrate the utility and improved care offered
by medical-psychiatric units, as well as integrated healthcare,
provision wherein a psychiatrist is a member of a general-medical
healthcare team. Both adult and child psychiatrists are included
in such settings. The psychiatrist can work with those patients
at greatest risk for psychiatric problems; educate, on an ongoing
basis, his medical and surgical colleagues; and quickly and efficiently
treat those individuals with identified psychiatric and substance-abuse
problems. The same principles operate within a medical-psychiatric
unit.
This book should be required reading for all psychiatric residents
and consultation–liaison fellows. For students and residents
who are unfamiliar with concepts such as "preferred provider
network," "utilization management," and "diagnosis-related
groups," this book is a must-read. It documents the financial
and clinical realities of our current dysfunctional system, but
also offers a model that builds upon the current psychosomatic
medicine specialists who link psychiatry with medicine. Only until
we can break down the isolated mental health, behavioral managed-care
companies and truly integrate healthcare financing, can we develop
a truly integrated and efficient healthcare system that does attend
to both "mind and body." For anyone who recognizes our
current dilemma, this book provides data about how we got there,
where we are currently, and suggestions for the future. One hopes
that Dr. Kathol will provide subsequent editions of this book to
upgrade the significant amounts of data within the volume. He has
rendered a great service to all of us with this volume.
Leslie R. Pyenson, M.D. (Psychiatr Serv 59:451-452, April 2008)
Almost any American can recite an example of how the U.S. health
care system has caused personal stress and frustration. The urgent
need for health care reform is debated regularly in the press,
on television, in blogs, and in movie documentaries. Roger Kathol
and Suzanne Gatteau offer a solution to an important aspect of
the problem through an examination of "a fragmented health
system, in which treatment of the mind (mental health) is severed
from the body (physical health), resulting in mindless health care." Following
the recommendations of an Institute of Medicine committee report
(1), Kathol and Gatteau outline a program to integrate the treatment
of physical and behavioral problems, which addresses concerns of
patients, health care providers, and health plans.
The authors' evidence-based accounts of patients with familiar
health complaints illuminate the problem: segregating treatment
of behavioral issues from medical issues results in persistent
health problems, increased costs, and a decline in employee productivity.
The authors note that patients with frequent somatic complaints
make excessive doctor and emergency room visits, resulting in two
million unnecessary hospital admissions per year, and adding an
estimated annual cost of $10 to $20 billion (2). Additionally,
the cost to businesses in the United States because of alcohol-
and drug-related disorders totals more than $100 billion a year.
Despite high expenditures on services, in terms of quality of health
care, treatment for alcohol dependence ranks last (3).
Rapidly rising health costs precipitated the development of a managed
care system to replace traditional fee-for-service insurance. The
managed care system was designed not only to deny coverage to patients
who use services excessively but also to eliminate unnecessary
procedures and tests. Unfortunately, this new system shifted decision-making
power from clinicians to health plan administrators. Medicine became
a business focused on quarterly profits and a favorable short-term
expense-to-income ratio, rather than on the long-term strategic
goal of improving overall health. The emphasis on treating physical
illness took precedence over treating behavioral problems, which
were historically perceived as unrelated to physical illness, overdiagnosed,
and unprofitable.
The authors describe the flaws in those perceptions. They outline
a new paradigm based on employer commitment, coordinated communication
among health care providers, and consolidated administration of
medical and behavioral health plan coverage, which would include
equitable reimbursement for behavioral health personnel based on
coding procedures used in physical medicine. They point out that
adopting their paradigm would decrease utilization of services,
lower health costs, increase employee productivity, and improve
overall health.
Dr. Kathol is an adjunct professor of internal medicine and psychiatry
at the University of Minnesota and president of Cartesian Solutions,
an integrated health care consulting company. He is a past president
of the American Academy of Clinical Psychiatry, the Academy of
Psychosomatic Medicine, and the Association of Medicine and Psychiatry.
His coauthor, Suzanne Gatteau, is a freelance writer.
Kathol's experience and Gatteau's writing skills have resulted
in a book that offers a logical, rational solution to a complex
health care problem. Health professionals, health plan administrators,
consumers, and legislators seeking a solution to problems resulting
from fragmented health care will find this book informative and
practical. Its publication is especially timely in a presidential
election year.
Cartesian Solutions, Inc.™
3004 Foxpoint Rd. - Burnsville, MN 55337
Phone: 952-426-1626 - Fax: 952-426-1200
E-mail: integration@cartesiansolutions.com
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