Literature Collection

People have infinite needs, including illness prevention, wellness, self-care, practical support, and quality of life. This article describes community-based, informal care programs that help people identify their needs, set goals, and organize networks of care to address their needs holistically in a way that can also significantly reduce healthcare costs. Approaches can be customized for primary care, home and community, hospice, and other care sectors to facilitate low-cost, high impact adoption. We provide a blueprint for programs that integrate informal and formal care across social, physical, and mental health domains as a key part of healthcare system transformation.

Interventions that integrate care for mental illness or substance use disorders into general medical care settings have been shown to improve patient outcomes in clinical trials, but efficacious models are complex and difficult to scale up in real-world practice settings. Existing payment policies have proven inadequate to facilitate adoption of effective integrated care models. This article provides an overview of evidence-based models of integrated care, discusses the key elements of such models, considers how existing policies have fallen short, and outlines future policy strategies. Priorities include payment policies that adequately support structural elements of integrated care and incentivize multidisciplinary team formation and accountability for patient outcomes, as well as policies to expand the specialty mental health and addiction treatment workforce and address the social determinants of health that disproportionately influence health and well-being among people with mental illness or substance use disorders.

This review explores the bidirectional relationship between mental health disorders and cardiovascular disease (CVD), highlighting the potential of integrated healthcare models to improve outcomes. While CVD remains the leading cause of global mortality, traditionally linked to risk factors like hypertension and diabetes, emerging evidence shows that mental health conditions, especially depression and anxiety, significantly increase CVD risk through mechanisms such as chronic stress, inflammation, and neuroendocrine dysregulation. Activation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system exacerbates inflammation, elevates blood pressure, and contributes to cardiovascular risk factors. Moreover, the psychological burden of CVD often worsens mental health, creating a vicious cycle that complicates treatment adherence and patient management. Integrated care models offer a holistic approach to address these interconnected issues, potentially improving clinical outcomes, reducing healthcare costs, and enhancing patient adherence. This review also explores the role of telehealth and digital health interventions in overcoming accessibility barriers, particularly for underserved populations. Finally, policy recommendations emphasize the need for increased funding, professional training in interdisciplinary care, and targeted outreach to ensure equitable access to integrated care. By addressing both CVD and mental health challenges, these models could improve quality of life and reduce the global burden of these intertwined diseases.

Policy Points There have been significant advancements in expanding care for opioid use disorder and suicide in general medical settings in the first quarter of the 21st century. Incessant barriers in the US health system continue to hinder progress in sufficiently scaling up evidence-based behavioral health interventions and getting them to those at highest risk. State policymakers have multiple levers available to make significant improvements to address ongoing challenges and improve access to evidence-based behavioral health services in emergency and primary care settings.