From Alienism to ACOs: Integrating Psychiatry, Again

This column describes the gradual integration of psychiatrists into mainstream general medical care, from their exile as “alienists” in isolated asylums to their current roles in accountable care organizations. The authors note that a contemporary form of alienism persists and argue that conceptual parity—the idea that mental illnesses exist within the same ontological realm as other illnesses—must first be achieved before full integration can be realized. Some steps toward achieving conceptual parity, such as the development of quality measures for behavioral health care and improved training programs, are described.