Providing Behavioral Health Care in a Primary Care Setting

Extensive barriers to accessing behavioral health care exist in the United States – affordability, access to a behavioral health provider, fear of stigma. Each of these barriers can be eliminated or reduced by folding behavioral health services into the primary care setting, or “integrating care.” A national survey published by the Mental Health Association found that 32% of undiagnosed, asymptomatic adults would likely turn to their primary care physician if mental health concerns arose while only 4% would seek care from a mental health specialist.

Flipping the coin over, a strong case can also be make for integrating primary care into the mental health treatment setting. 68% of those living with mental illness in the United States also suffer from a chronic physical condition such as diabetes, hypertension and/or heart disease. The life expectancy of adults living with mental illness is reduced by over ten years due to their chronic conditions – not their mental illnesses. Thus those who regularly consult a psychiatrist or other provider regularly for counseling or medication management for their mental illnesses stand to benefit from the opportunity to obtain affordable primary care during the same visit.

Tarzana Treatment Centers in Southern California, serves as an example of successful integration. Dr. Jose Salazar of Tarzana explains, “Patients typically report higher satisfaction rates with health services that are fully integrated as opposed to those that are not,” while benefits to the provider include improved patient adherence and increased follow up to care.  Additionally, “many fully integrated care programs see their patient emergency department utilization reduce by 20%-30% [or higher],” lending our general healthcare system additional benefits from full integration.

The transition to an integrated care system is not without its challenges, particularly relating to an organization’s limited financial and human resources. Dr. Salazar explains that full integration of behavioral and medical care adds a valuable care component that may not be fully or even partially covered by third party reimbursement, such as case management and care coordination. Having undergone this transition already, staff members at Tarzana recognize now that “it is also important to change the culture and mindset of providers via training and development to operate in this new model, which has its own set of principles, values, and communication approaches.”

The transition to integrated care is a seismic shift in the way health care is considered and delivered. Through holistic care approaches – primary care integrating behavioral health and vice versa – these innovative organizations are ensuring that no patient is defined by a single diagnosis, but rather is understood and respected as a sum of his or her parts.