Bright idea: Integrating behavioral health with primary care

Published April 18, 2017

Why are more primary care practices providing behavioral health services?

Depression, anxiety and other mental health conditions affect millions of Americans. In fact, the Blue Cross Blue Shield Health Index SM finds that mood disorders have a greater impact on health than any other condition. Mental health problems can be debilitating, preventing people from fully participating in work, school and family life.

For decades, treatment for mental health conditions was separate from treatment for other forms of illness, a segregated approach that stigmatized those who suffer from behavioral and mood disorders, and left too many without access to appropriate care.

Offering behavioral health services through primary care practices changes that equation.

It makes it easier for patients to see a psychiatrist or psychologist, obtain psychiatric medications or engage in talk therapy. It also helps remove the stigma around seeking care for mental health issues. And it enables primary care doctors and mental health practitioners to coordinate well-rounded treatment plans for patients, addressing their health needs holistically to achieve better outcomes.

How are physical and mental health related?

Mental and physical health are closely intertwined. Patients facing a serious medical condition, such as cancer or heart disease, may experience depression or anxiety as they come to terms with their diagnosis. In addition, patients with certain behavioral health concerns may find it hard to comply with medication regimens or lifestyle changes. For example, a patient with severe depression might struggle to get prescriptions filled in time or make doctor’s appointments.

The two are also closely tied to medical costs. Research finds that people with chronic conditions accompanied by depression or anxiety face far higher medical costs than those suffering from a physical illness alone.

Bridging the gap between primary and behavorial health
Blue Cross Blue Shield of Western New York launched a pilot integrated healthcare program where patients saw a primary care doctor, a clinical licensed social worker, and a psychiatrist.

How are primary care practices integrating behavioral healthcare?

Physician groups are hiring psychiatrists, psychologists, social workers and nurses trained in psychiatric care. Some practices are adding case managers to coordinate patients’ mental health care. Others allow patients to see a psychiatrist or counselor right in primary care physicians’ offices. And nearly all of them are educating and training doctors and nurses about how to identify and help patients manage their behavioral health needs.

At Amherst Pediatrics in Buffalo, New York, for example, the practice added a licensed mental health counselor to its staff. Now parents who are concerned that their child may have Attention-Deficit Disorder, depression, Obsessive-Compulsive Disorder (OCD) or other behavioral health conditions no longer need to seek a referral to a mental health specialist and travel to another location to be seen. They can bring their child to their pediatrician’s office for treatment. It’s part of a movement to create “medical homes” that coordinate and integrate all aspects of a patient’s care.

What are the results?

In a word: impressive. Emergency room visits dropped more than 23 percent for patients in practices that incorporated behavioral healthcare, according to a study published in the Journal of the American Medical Association. Due to more frequent screenings, more than 46 percent of patients in these practices were diagnosed with depression, compared to just 24 percent of patients in traditional practices. And nearly half of the patients in integrated practices had a mental healthcare plan, compared to just 8 percent of patients seen by standard primary care doctors.