Behavioral health primary care integration

Integrating behavioral health into primary care practice brings mental health and/or substance abuse screenings and treatments into a primary care setting. These efforts can include coordination between primary care providers, case managers or behavioral health consultants, and mental health specialists (e.g., psychiatrists), and often, require training and redefinition or realignment of staff roles (SAMHSA-HRSA Integrate, CG-Mental health). Mental health conditions and substance abuse issues often occur with other chronic medical conditions; patients with severe conditions are referred to specialty care (SAMHSA-HRSA Integrate).

Expected Beneficial Outcomes (Rated)

  • Improved mental health

  • Increased adherence to treatment

  • Improved quality of life

  • Increased patient engagement

Other Potential Beneficial Outcomes

  • Reduced drug and alcohol use

Evidence of Effectiveness

There is strong evidence that integrating behavioral health into primary care practice improves mental health (ICER-Tice 2015, ), especially depression symptoms (ICER-Tice 2015, CG-Mental health, , ). Integrating care also increases patients’ adherence to treatment, improves their quality of life (), and increases satisfaction (ICER-Tice 2015) and engagement with health care providers (Wissow 2013).

Integrating depression screening and treatment into primary care has been shown to improve depression symptoms for adolescent, adult, and elderly patients (CG-Mental health, Butler 2008). Such care appears effective in various settings, including practices with limited resources and practices in rural and urban areas (CG-Mental health, , Serrano 2011).

Collaborative care approaches  that use case managers to organize and integrate behavioral and primary care improve response to treatment, increase remission and recovery from symptoms, and increase satisfaction with care among patients with depression in the short- and long-term (CG-Mental health, ). Coordination which includes regular and planned psychiatrist supervision of case managers has been shown to be more effective than efforts with unplanned supervision (). For patients suffering from chronic pain and substance abuse disorders in addition to depression, multiple interventions in primary care settings (e.g., motivational interviewing and cognitive behavioral therapy) may more effectively improve mental health and reduce drug and alcohol use than a single intervention ().

Universal mental health screening during pediatric appointments can increase parent, youth, and primary care provider willingness to discuss mental health concerns. Framing screening as universal, confidential, and designed to improve communication may further support patient and family engagement (Wissow 2013).

Economic studies indicate that integrating behavioral health and primary care to treat depression is associated with greater costs and better health outcomes than traditional care models. Overall, studies have shown integrated care to be cost effective in terms of quality adjusted life years (QALYs) saved (CG-Mental health).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

There are several models to integrate behavioral health into primary care practice. The AIMS center at the University of Washington and the DIAMOND program in Minnesota are two examples. AIMS’ Collaborative Care model to treat depression and anxiety is based on five core principles: patient-centered team care, population-based care, measurement-based treatment to target, evidence-based care, and accountable care (AIMS-Collaborative care). This model utilizes a core team of primary care providers, behavior health providers or case managers, and psychiatrist consultants (, ICER-Tice 2015). The DIAMOND program uses these same components for patients with depression, changing both how care is delivered and how it is paid for (ICSI-DIAMOND).

Implementation Resources

AIMS-Collaborative care - Collaborative Care. Advancing Integrated Mental Health Solutions (AIMS). University of Washington.

ICSI-DIAMOND - DIAMOND for depression. Institute for Clinical Systems Improvement (ICSI).

SAMHSA-HRSA Integrate - Integrate behavioral health into primary care. SAMHSA-HRSA Center for Integrated Health Solutions.

WIPHL - Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL).

AHRQ-Integrate - Agency for Healthcare research and Quality (AHRQ). The Academy: Integrating behavioral health and primary care.

Citations - Evidence

* Journal subscription may be required for access.

CG-Mental health - The Guide to Community Preventive Services (The Community Guide). Mental health.

Cochrane-Bower 2011* - Bower P, Knowles S, Coventry, PA, Rowland N. Counselling for mental health and psychosocial problems in primary care: Review. Cochrane Database of Systematic Reviews. 2011;(9):CD001025.

Butler 2011* - Butler M, Kane RL, McAlpine D, et al. Does integrated care improve treatment for depression: A systematic review. The Journal of Ambulatory Care Management. 2011;34(2):11-25.

Gilbody 2006a* - Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine. 2006;166(21):2314-21.

Haibach 2014* - Haibach JP, Beehler GP, Dollar KM, Finnell DS. Moving toward integrated behavioral intervention for treating multimorbidity among chronic pain, depression, and substance-use disorders in primary care. Medical Care. 2014;52(4):322-27.

Thota 2012* - Thota AB, Sipe TA, Byard GJ, et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. American Journal of Preventive Medicine. 2012;42(5):525-38.

Wissow 2013 - Wissow LS, Brown J, Fothergill KE, et al. Universal mental health screening in pediatric primary care: A systematic review. Journal of the American Academy of Child and Adolescent Psychiatry. 2013;52(11):1134-1147.e23.

Berger-Jenkins 2012* - Berger-Jenkins E, McCord M, Gallagher T, Olfson M. Effect of routine mental health screening in a low-resource pediatric primary care population. Clinical Pediatrics. 2012;51(4):359-65.

Butler 2008 - Butler M, Kane RL, McAlpine D, et al. Integration of mental health/substance abuse and primary care. Rockville: Agency of Healthcare Research and Quality (AHRQ); 2008.

Serrano 2011 - Serrano N, Monden K. The effect of behavioral health consultation on the care of depression by primary care clinicians. WMJ. 2011;110(3):113-119.

ICER-Tice 2015 - Tice JA, Ollendorf DA, Reed SJ, et al. Integrating behavioral health into primary care. Institute for Clinical and Economic Review (ICER); 2015.

Citations - Implementation Examples

* Journal subscription may be required for access.

AIMS-Collaborative care - Collaborative Care. Advancing Integrated Mental Health Solutions (AIMS). University of Washington.

ICSI-DIAMOND - DIAMOND for depression. Institute for Clinical Systems Improvement (ICSI).

ICER-Tice 2015 - Tice JA, Ollendorf DA, Reed SJ, et al. Integrating behavioral health into primary care. Institute for Clinical and Economic Review (ICER); 2015.

Raney 2015* - Raney LE. Integrating primary care and behavioral health: The role of the psychiatrist in the collaborative care model. 2015;172(8): 721-728.

Date Last Updated

Aug 28, 2015