Why Mental Health Care Should Be Part of Primary Care

The Primary Care Behavioral Health  model aims to increase access to care with benefits for providers, patients, and our entire health care system.   

Almost a third of American adults have a diagnosable substance use and/or psychiatric disorder, and half will experience such a disorder in their lifetime. Yet the mental health system is unable to meet the needs of the population, so primary care providers are left to pick up the slack.

The pandemic years, rife with isolation, stress, and disruption in all areas of life, exacerbated and spotlighted this problem. Mental health problems surged far beyond the capacity of the mental health system, leaving more and more people seeking help through primary care providers — or, worse, going without help.

When people do receive mental health treatment, there’s a good chance they get it not on a therapist’s couch but in a primary care exam room. Only 8% of the U.S. population will see a therapist during a given year. Instead, about 76% of all outpatient mental health treatment in the U.S. is delivered through primary care.

Even before the pandemic, primary care doctors and clinics were underprepared and lacked the resources to treat behavioral health issues. This has led many to ask, is there a better way?

Today, more primary care clinics than ever before are owned by health care systems, rather than being independent practices. Typically a main motivator for a system to buy a primary care practice is to generate more business for their specialty services, because primary care is the main source of referrals to specialty care — not just mental health care, but all specialties. Specialty care costs more than primary care, so the systems make more money if they have in-house primary care generating referrals to in-house specialists.

This idea does have some appeal when it comes to mental health. Primary care provides far more mental health treatment than the specialty mental health system does, so there’s an opportunity for generating more revenue if a health care system’s primary care providers refer a lot of patients to the same system’s mental health providers.

There’s a problem with this approach, however. Most patients referred to mental health through primary care either can’t get into care for a long time or opt not to go. There’s no clear evidence that referring patients to in-house mental health specialists results in more of them using the specialty service vs. referring patients out to services in the community.

Thus, primary care needs to try a different approach when it comes to mental health — one that brings mental health professionals onto the primary care team, where they can help the team manage the many patients seen for mental health problems who do not go to specialty mental health or can’t get seen in a timely fashion.

Including mental health professionals in primary care teams provides numerous wins. For example, it can help providers better:

• Treat patients with mental health problems.
• Facilitate patients getting into mental health specialists, when appropriate.
• Generate revenue for the mental health provider’s services in primary care.

This strategy is called “integrated primary care behavioral health” or “PCBH” for short. Many primary care clinics around the country are adopting it, both as a way of generating more revenue and as a way of providing better care to their primary care patients. Doing so can help address some of the major problems facing health care, including improving access for patients to mental health care, providing relief for overworked primary care providers, and providing whole-person care rather than treating mental and physical health needs in isolation.

While the traditional approach to mental health focuses on improving outcomes for individual patients, PCBH aims to improve the health of individuals by raising the health of the population. The reason: Research has shown that countries with the most robust primary care have better health outcomes, lower health care costs, and fewer disparities in care.

Unfortunately, the U.S. has not been one of these countries. Our primary care clinics are stressed with clinical, operational, financial, and workforce challenges. However, the PCBH model can help alleviate many of these challenges by: 1. Strengthening primary care; and 2. Reaching large numbers of patients.

The first strategy involves tactics such as improving primary care physicians’ comfort and skills for working with behavioral health issues. Doing so can increase their job satisfaction and decrease turnover.

The second strategy is rooted in the idea that lower intensity interventions delivered to a large number of people can equal or surpass the benefits of high intensity interventions delivered to a small number of people. The PCBH approach, like primary care itself, is about expanding access to care.

The PCBH model is designed to address many of the challenges now stressing primary care and the mental health system. By including behavioral health professionals as part of primary care teams, we can empower them to better serve patients they are already seeing, and  expand access to mental health care when and where patients need it.

Written by Jeffrey Reiter, Ph.D., ABPP.
Have you read?
The World’s Best Medical Schools.
The World’s Best Universities.
The World’s Best International High Schools.
The World’s Best Business Schools.
The World’s Best Fashion Schools.
The World’s Best Hospitality And Hotel Management Schools.