Literature Collection

This Grantmakers in Health Bulletin article, authored by NYSHealth Senior Program Director Jacqueline Martinez Garcel and NYSHealth Chief Program Learning Officer Kelly Hunt, examines the lack of integrated care for people with co-occurring mental health and substance use disorders and how NYSHealth has supported efforts to transform the systems of care for New Yorkers coping with both conditions.Care for people with co-occurring conditions remains terribly fragmented. Three separate systems exist - health, mental health, and substance use services - to care for each individual problem, each one with its own set of norms, culture, regulations, reimbursement process, and accountability. These siloed systems of care have led to a revolving door for people seeking help. To help transform the systems of care, NYSHealth established the Center for Excellence in Integrated Care (the Center), the first-of-its-kind in New York State. As of the end of 2012, the Center has worked with more than 600 mental health and substance use outpatient sites to help them fully integrate services for patients with co-occurring disorders. The article looks at the approach and impact of integrating care across the two systems, the outcomes to date, and how this can be a model for care management teams.

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.