Integrating Behavioral Health Care into the Primary Health Care Settings

  Current State of Behavioral Health Care and Its Separation from Primary Health Care

The landscape of behavioral health care currently operates largely in isolation from primary health care. Behavioral health care, which encompasses mental health and substance abuse conditions, have historically had distinct methods of authorization, finance, regulation, research, and structure. 1 Patients often have to navigate different systems for physical health, mental health, and substance abuse conditions. This fragmentation results in logistical complications, from additional referrals and assessments to prolonged waiting periods for treatment. The divide perpetuates stigma around mental health, casting it as less urgent or legitimate than physical health issues. 2

Importance of Integrating Behavioral Health Care into Primary Health Care Settings

The integration of behavioral health care into primary health care is vital for several reasons. It is a shift towards a person-centered model of care, where the patient is treated as a whole being with interconnected mental and physical health needs. Integration also increases access to behavioral health care considering patients visit their primary care provider more often throughout the year than specialists. By addressing mental health and substance abuse in primary care settings, professionals on the frontline can detect issues earlier and promptly commence treatment, potentially averting more severe complications down the line.

Benefits of Behavioral Health Integration in the Primary Healthcare Setting

Primary care is often the first point of contact for patients within the healthcare system. Integrating behavioral health services into this setting allows for earlier identification and management of behavioral health conditions. Early diagnosis and treatment are crucial for many mental health and substance abuse disorders and can substantially improve outcomes and the quality of life for patients.

Key Benefits of Integration

1. Improvement in overall health: Chronic physical health conditions often co-occur with mental health and substance abuse conditions. Integration addresses both behavioral and physical health concerns often leading to improved health outcomes. 
2. Enhanced patient experience: An integrated system allows for increased access to care in a setting that is familiar, comfortable, and convenient to the patient. 
3. Valuable provider partnerships: Primary care and behavioral health care providers are able to team up to provide holistic care to patients in an integrated system. A collaborative and supportive practice environment enhances providers’ experience of care and decreases the risk of burnout.
4. Cost effectiveness: Integration decreases mental health care costs by reducing the number of visits to emergency departments and preventing possible inpatient hospital stays.4,5

Prompt Referrals

Having a basic understanding of mental health and substance abuse assessments enables primary care providers to make more timely and appropriate referrals to specialized behavioral health services. This facilitates the treatment process and ensures that patients get the specific care they need more quickly.

According to a cross-sectional study assessing primary care contributions to behavioral health using 2016-2018 Medical Expenditure Panel Survey data, 6 primary care physicians provided a substantial amount of care for depression, anxiety and any mental illness. This emphasized the importance of behavioral health education and training for healthcare professionals working in a primary care setting.

Reduced Stigma

By incorporating mental health and substance abuse assessments into routine primary care, providers help normalize the discussion around mental illness and substance use, thereby reducing stigma and encouraging more patients to seek help.

Efficient Use of Resources

Effective care for behavioral health conditions in the primary care setting can prevent the overuse or misuse of healthcare resources. For example, providers who understand that stress increases anxiety and may cause physical symptoms such as headaches, stomach pain, or sleep disturbances can prevent unnecessary tests, treatments, or hospital admissions.

Familiarization with behavioral health conditions and assessments is imperative for primary care providers. The challenges of limited access to behavioral health care services, a shortage of specialized mental health professionals, and prevailing stigmas make the role of primary care providers all the more crucial.

By embracing behavioral health as a key aspect of primary care, earlier diagnosis, better patient outcomes, and more cost-effective treatment can be achieved. Integration offers a solution to some of the barriers that hinder access to behavioral health services, particularly in settings where specialist care is scarce or stigmatized. Furthermore, this holistic person-centered approach promises not only individual benefits but broader societal advantages, including less strain on healthcare systems and improved public well-being.

The conversation about mental health and substance abuse must shift from being a specialized dialogue to a mainstream, inclusive discourse. This change starts at the grassroots level of primary care. As the lines between physical and mental health continue to blur, the time to move towards a healthcare model that serves the complete needs of the individual and the collective well-being of society is now.

1. Integration of mental and general health care [Position statement]. Mental Health America. Last reviewed December 31, 2022. Accessed September 20, 2023. https://mhanational.org/issues/position-statement-13-integration-mental-and-general-health-care#_edn2
2. What is stigma? National Alliance on Mental Illness. Accessed September 20, 2023. https://nami.org/Get-Involved/Pledge-to-Be-StigmaFree?gad=1&gclid=CjwKCAjwsKqoBhBPEiwALrrqiGnWxhq-T5-MyFZYXjzBVsnSYCsh9C5dDCe_C  jGo1AV1iSyRW5aTfxoCSQAQAvD_BwE
3. HHS roadmap for behavioral health integration. US Department of Health and Human Services. December 2, 2022. Accessed September 20, 2023. https://www.hhs.gov/about/news/2022/12/02/hhs-roadmap-for-behavioral-health-integration-fact-sheet.html
4. What is integrated behavioral health? Agency for Healthcare Research and Quality. Accessed September 20, 2023. https://integrationacademy.ahrq.gov/about/integrated-behavioral-health
5. Behavioral health integration fact sheet. American Psychological Association. June 2, 2022. Accessed September 20, 2023. https://www.apa.org/health/behavioral-integration-fact-sheet
6. Jetty A, Petterson S, Westfall JM, Jabbarpour Y. Assessing Primary Care Contributions to Behavioral Health: A Cross-sectional Study Using Medical Expenditure Panel Survey. J Prim Care & Community Health. 2021;12. doi:10.1177/21501327211023871

Dr. Beth A. Pratt earned a Doctor of Philosophy in nursing and Master of Science in nursing education from Florida Atlantic University, a Master of Science in forensic science from Florida International University, a Bachelor of Science in nursing from Johns Hopkins University, a Bachelor of Arts in biology from St. Olaf College and a Second Major in Spanish from St. Catherine University. Dr. Pratt began her career in labor and delivery and had the opportunity to nurse in other areas including public health, infertility, antepartum home health, and nursing education. Dr. Pratt is passionate about holistic health and conducts research on complementary interventions to enhance wellness.