Mental Healthcare in a Primary Care Clinic

Integrated behavioral health is an evolving way of organizing the care people receive when they go to a primary care clinic. When behavioral health is integrated with your primary care, your primary care team can more easily address both your physical and mental health concerns, including problems like anxiety and depression. When these areas of your health are understood and addressed together, you have a better chance of being healthy.

All primary care clinics will see mental health issues in their patients because mental health and behavioral problems are so common. Integrated care clinics will be equipped to address those issues but may vary in their approach and capacity. The following are definitions of the most common team members in integrated care and the services they may offer.

Behavioral health specialists – A behavioral health specialist may be available to help you with key health-related behaviors such as smoking, weight gain, etc., or to assist you in understanding your mental health issues and/or challenges in relationships in your family.

Care managers – In many clinics, care managers are health care professionals who provide a number of supportive services such as coordinating care between your different doctors, helping you with appointments, providing referrals to specialists, or providing resources for needs like transportation or housing.

Collaborative Care behavioral health care managers – In the Collaborative Care Model, behavioral health care managers are specialized providers embedded into your primary care team with a specified role to maintain contact with you while you are in the Collaborative Care program. These individuals may be nurses, counselors, or social workers. They work closely with your primary care clinician and a psychiatry clinician to provide you with integrated mental health care. They provide some direct behavioral health care services and coordinate consultation between psychiatry and primary care if medications are involved.

Psychiatric clinicians – Psychiatric clinicians may be on-site to see some of the primary care patients or serve as virtual consultants to primary care. These clinicians can be medical doctors (psychiatrists), physician assistants or advanced practice nurses. They can help clarify a mental health diagnosis, assist in developing a treatment plan, support the primary care clinician with beginning or managing medications, and assist in accessing higher levels of care if needed. While your primary care clinician can prescribe psychiatric medication, a psychiatrist or other mental health care clinician may be more familiar with these medications. Their expertise and support can help ensure quality care.

Psychotherapists – Some clinics may offer psychotherapy onsite to help patients address common mental health challenges such as anxiety, depression and other concerns. The therapy is usually provided by psychologists, licensed counselors or social workers. Psychotherapy within primary care can be brief and highly effective.

Examples of Integrated Care Services

Here are examples of services that you might find in an integrated setting that are less common in other primary care sites:

• Routine screening for mental health conditions that are often associated with worse medical outcomes.
• Several visits with a therapist to get over a fear of social settings or going on an airplane or a fear of needles.
• Cognitive behavioral therapy for depression, anxiety and other conditions.
• Specific therapies for sleep issues or chronic pain.
• Programs that track your mood through frequent contact via phone or virtually and offer changes in treatment until it is clear you are getting better.
• A clear diagnostic interview to identify medical and psychiatric issues that may be present in your life.
• Help to start and stabilize on antidepressants or medications for other conditions.
• Assistance in identifying social challenges that may make it hard to follow your planned treatment (such as problems with insurance, transportation, housing or food insecurity, etc.)
• Targeted referrals to the right types of mental health assistance in your community.
   

Does integrated care mean all my care needs will happen in primary care?

Integrated care does not mean that all care needs are addressed at your primary care clinic. However, clinicians will be more ready to begin helping you with these problems or more aware of the best referral options that match your needs.

I know there are mental health clinics and therapists in the community and online. Why not just go there?

Integrated behavioral health in primary care is not expected to replace those services, but many patients say that it is hard to access specialty services or they don’t feel comfortable going somewhere new for services. Having some of these resources within or linked to primary care means that when a patient is seen for their diabetes, for example, they can also be screened for depression and their treatment plan can address both issues. Integrated care clinicians will also try to make sure the mental health care you are receiving outside the clinic is matched to your needs.

What are some of the differences I might see if I went to a clinic that provides integrated behavioral health?

Clinics across the country are at various stages of moving to integrated care, so you may not find the same thing everywhere. However, common elements include:

• Screening – Brief screening for the most common mental health conditions, like depression, anxiety or alcohol use, to try and catch these problems early.
• Tracking – These same screening tools can also be used to track your treatment progress much like you might do with weight or your blood pressure.

I am comfortable with my primary care doctor. Will they still be included in this part of my care?

Absolutely. Integrated behavioral health is meant to enhance and support the work of primary care clinicians. They will have a key role in overall care and are often the ones writing prescriptions if needed or connecting you with services.

Will insurance cover these services?

Most insurance will cover some of these services. For example, Collaborative Care is covered by Medicare and many private insurance companies as well. Individual therapy is also generally covered by insurance. You may have copays or deductibles depending on your particular coverage. Some studies have shown that getting care earlier in primary care can save money and reduce the need for higher cost services later on.

Physician Review

Members of the APA Committee on Integrated Care

• Shannon Kinnan, M.D., Chair
• Julienne Aulwes, M.D.
• Henry Chung, M.D.
• Thomas Heinrich, M.D.
• Ken Hopper, M.D., M.B. A.
• Virginia O'Brien, M.D.
• Nick Tamoria, M.D.
• Mark Williams, M.D.
• Maureen Maguire, J.D.

January 2024