Abstract
It is now widely accepted that there is a growing discrepancy between demand and access to adequate treatment for behavioral or mental health conditions in the United States. This results in immense personal, societal, and economic costs. One rapidly growing method of addressing this discrepancy is to integrate mental health services into the primary care setting, which has become the de facto service provider for these conditions. In this paper, we describe the development and implementation of a novel integrated care program in a large mid-western university-based healthcare system, drawn from the collaborative care model, and describe the benefits in terms of both health care utilization and depression outcomes. Limitations and proposed future directions are discussed.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
N/A.
Code Availability
N/A.
References
Advancing Integrated Mental Health Solutions (AIMS) Center. (2020, December 7). Evidence base for collaborative care. Retrieved from https://aims.uw.edu/resource-library/evidence-base-collaborative-care.
Advancing Integrated Mental Health Solutions (AIMS) Center a. (n.d.). Behavioral health care manager. Retrieved from https://aims.uw.edu/collaborative-care/team-structure/care-manager
Advancing Integrated Mental Health Solutions (AIMS) Center b. (n.d.). Principles of collaborative care. Retrieved from https://aims.uw.edu/collaborative-care/principles-collaborative-care
American Psychological Association, Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. The American Psychologist, 61(4), 271–285. https://doi.org/10.1037/0003-066X.61.4.271
American Psychiatric Association, Academy of Psychosomatic Medicine (2016). Dissemination of integrated care within adult primary care settings. Retrieved from https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/Integrated-Care/APA-APM-Dissemination-Integrated-Care-Report.pdf
Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., Dickens, C., & Coventry, P. (2012). Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD006525.pub2
Asarnow, J. R., Rozenman, M., Wiblin, J., & Zeltzer, L. (2015). Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: A meta-analysis. JAMA Pediatrics, 169(10), 929. https://doi.org/10.1001/jamapediatrics.2015.1141
Benkert, R., Hollie, B., Nordstrom, C. K., Wickson, B., & Bins-Emerick, L. (2009). Trust, mistrust, racial identity and patient satisfaction in urban African American primary care patients of nurse practitioners. Journal of Nursing Scholarship, 41(2), 211–219. https://doi.org/10.1111/j.1547-5069.2009.01273.x
Bishop, T. F., Seirup, J. K., Pincus, H. A., & Ross, J. S. (2016). Population of US practicing psychiatrists declined, 2003–13, which may help explain poor access to mental health care. Health Affairs, 35(7), 1271–1277. https://doi.org/10.1377/hlthaff.2015.1643
Butler, M., Kane, R. L., McAlpine, D., Kathol, R. G., Fu, S. S., Hagedorn, H., & Wilt, T. J. (2008). Integration of mental health/substance abuse and primary care. In Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. Centre for Reviews and Dissemination (UK). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK76532/
Cooper, L. A., Gonzales, J. J., Gallo, J. J., Rost, K. M., Meredith, L. S., Rubenstein, L. V., Wang, N.-Y., & Ford, D. E. (2003). The acceptability of treatment for depression among African-American, Hispanic, and white primary care patients. Medical Care, 41(4), 479–489. https://doi.org/10.1097/01.MLR.0000053228.58042.E4
Coventry, P., Lovell, K., Dickens, C., Bower, P., Chew-Graham, C., McElvenny, D., Hann, M., Cherrington, A., Garrett, C., Gibbons, C. J., Baguley, C., Roughley, K., Adeyemi, I., Reeves, D., Waheed, W., & Gask, L. (2015). Integrated primary care for patients with mental and physical multimorbidity: Cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. BMJ, 350, h638. https://doi.org/10.1136/bmj.h638
Charlson, M., Szatrowski, T. P., Peterson, J., & Gold, J. (1994). Validation of a combined comorbidity index. Journal of Clinical Epidemiology, 47(11), 1245–1251. https://doi.org/10.1016/0895-4356(94)90129-5
Cunningham, P. J. (2009). Beyond parity: Primary care physicians’ perspectives on access to mental health care: More PCPs have trouble obtaining mental health services for their patients than have problems getting other specialty services. Health Affairs, 28(Supplement 1), w490–w501. https://doi.org/10.1377/hlthaff.28.3.w490
Firth, Joseph, Solmi, Marco, Wootton, Robyn E., Vancampfort, Davy, Schuch, Felipe B., Hoare, Erin, Gilbody, Simon, Torous, John, Teasdale, Scott B., Jackson, Sarah E., Smith, Lee, Eaton, Melissa, Jacka, Felice N., Veronese, Nicola, Marx, Wolfgang, Ashdown-Franks, Garcia, Siskind, Dan, Sarris, Jerome, Rosenbaum, Simon, & Stubbs, Brendon. (2020). A meta-review of “lifestyle psychiatry”: The role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry, 19(3), 360–380. https://doi.org/10.1002/wps.20773
Gilbody, S. (2006). Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166(21), 2314. https://doi.org/10.1001/archinte.166.21.2314
Health Resources and Services Administration/National Center for Health Workforce Analysis; Substance Abuse and Mental Health Services Administration/Office of Policy, Planning, and Innovation. (2015). National projections of supply and demand for behavioral health practitioners: 2013–2025. MD: Rockville.
Huang, F. Y., Chung, H., Kroenke, K., Delucchi, K. L., & Spitzer, R. L. (2006). Using the patient health questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. Journal of General Internal Medicine, 21(6), 547–552. https://doi.org/10.1111/j.1525-1497.2006.00409.x
Kathol, R. G., Butler, M., McAlpine, D. D., & Kane, R. L. (2010). Barriers to physical and mental condition integrated service delivery. Psychosomatic Medicine, 72(6), 511–518. https://doi.org/10.1097/PSY.0b013e3181e2c4a0
Katon, W., Berg, A. O., Robins, A. J., & Risse, S. (1986). Depression—medical utilization and somatization. Western Journal of Medicine, 144(5), 564–568.
Katon, W., Lin, E. H. B., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., Peterson, D., Rutter, C. M., McGregor, M., & McCulloch, D. (2010). Collaborative care for patients with depression and chronic illnesses. The New England Journal of Medicine, 363(27), 2611–2620. https://doi.org/10.1056/NEJMoa1003955
Katon, W., Russo, J., Lin, E. H. B., Schmittdiel, J., Ciechanowski, P., Ludman, E., Peterson, D., Young, B., & Von Korff, M. (2012). Cost-effectiveness of a multicondition collaborative care intervention. Archives of General Psychiatry, 69(5), 506. https://doi.org/10.1001/archgenpsychiatry.2011.1548
Katon, W., & Sullivan, M. D. (1990). Depression and chronic medical illness. The Journal of Clinical Psychiatry, 51, 3–14.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Lanoye, A., Stewart, K. E., Rybarczyk, B. D., Auerbach, S. M., Sadock, E., Aggarwal, A., Waller, R., Wolver, S., & Austin, K. (2017). The impact of integrated psychological services in a safety net primary care clinic on medical utilization. Journal of Clinical Psychology, 73(6), 681–692. https://doi.org/10.1002/jclp.22367
Mancini, M. A. (2021). Integrated Behavioral Health Practice. Springer International Publishing.
McGinty, E. E., & Daumit, G. L. (2020). Integrating mental health and addiction treatment into general medical care: The role of policy. Psychiatric Services, 71(11), 1163–1169. https://doi.org/10.1176/appi.ps.202000183
Miranda, J., & Cooper, L. A. (2004). Disparities in care for depression among primary care patients. Journal of General Internal Medicine, 19(2), 120–126. https://doi.org/10.1111/j.1525-1497.2004.30272.x
National Institute of Mental Health. (2021). Mental illness. Retrieved from https://www.nimh.nih.gov/health/statistics/mental-illness
Peek, C. J., & the National Integration Academy Council. (2013). Lexicon for behavioral health and primary care integration (AHRQ Publication No. 13-IP001-EF). MD: Rockville.
Rost, K., Pyne, J. M., Dickinson, L. M., & LoSasso, A. T. (2005). Cost-Effectiveness of enhancing primary care depression management on an ongoing basis. Annals of Family Medicine, 3(1), 7–14. https://doi.org/10.1370/afm.256
Sanchez, K., Thompson, S., & Alexander, L. (2010). Current strategies and barriers in integrated health care: A survey of publicly funded providers in Texas. General Hospital Psychiatry, 32(1), 26–32. https://doi.org/10.1016/j.genhosppsych.2009.10.007
Sawchuk, C. N., Craner, J. R., Berg, S. L., Smyth, K., Mack, J., Glader, M., Burke, L., Haggerty, S., Johnson, M., Miller, S., Sedivy, S., Morcomb, D., Heredia, D., Williams, M. W., & Katzelnick, D. J. (2018). Initial outcomes of a real-world multi-site primary care psychotherapy program. General Hospital Psychiatry, 54, 5–11. https://doi.org/10.1016/j.genhosppsych.2018.06.005
Shippee, N. D., Mattson, A., Brennan, R., Huxsahl, J., Billings, M. L., & Williams, M. D. (2018). Effectiveness in regular practice of collaborative care for depression among adolescents: A retrospective cohort study. Psychiatric Services, 69(5), 536–541. https://doi.org/10.1176/appi.ps.201700298
Simon, G., Ormel, J., VonKorff, M., & Barlow, W. (1995). Health care costs associated with depressive and anxiety disorders in primary care. The American Journal of Psychiatry, 152(3), 352–357. https://doi.org/10.1176/ajp.152.3.352
Singal, A. G., Higgins, P. D., & Waljee, A. K. (2014). A primer on effectiveness and efficacy trials. Clinical and Translational Gastroenterology, 5(1), e45. https://doi.org/10.1038/ctg.2013.13
Solberg, L. I., Crain, A. L., Jaeckels, N., Ohnsorg, K. A., Margolis, K. L., Beck, A., Whitebird, R. R., Rossom, R. C., Crabtree, B. F., & Van de Ven, A. H. (2013). The DIAMOND initiative: Implementing collaborative care for depression in 75 primary care clinics. Implementation Science: IS, 8, 135. https://doi.org/10.1186/1748-5908-8-135
Spring, B., Pagoto, S., Kaufmann, P. G., Whitlock, E. P., Glasgow, R. E., Smith, T. W., Trudeau, K. J., & Davidson, K. W. (2005). Invitation to a dialogue between researchers and clinicians about evidence-based behavioral medicine. Annals of Behavioral Medicine, 30(2), 125–137. https://doi.org/10.1207/s15324796abm3002_5
Strosahl, K. (1997). Building primary care behavioral health systems that work: A compass and a horizon. Behavioral health in primary care: A guide for clinical integration (pp. 37–58). Psychosocial Press.
Substance Abuse and Mental Health Services Administration (n.d.). Standard framework for levels of integrated healthcare. Retrieved from https://www.integration.samhsa.gov/resources/standard-framework-for-levels-of-integrated-healthcare
Unützer, J., Katon, W. J., Fan, M.-Y., Schoenbaum, M. C., Lin, E. H. B., Penna, R. D. D., & Powers, D. (2008). Long-term cost effects of collaborative care for late-life depression. The American Journal of Managed Care, 14(2), 95–100.
Wells, K. B., Stewart, A., Hays, R. D., Burnam, M. A., Rogers, W., Daniels, M., Berry, S., Greenfield, S., & Ware, J. (1989). The functioning and well-being of depressed patients. Results from the medical outcomes study. JAMA, 262(7), 914–919.
Williams, A. A. (2020). The next step in integrated care: universal primary mental health providers. Journal of Clinical Psychology in Medical Settings, 27(1), 115–126. https://doi.org/10.1007/s10880-019-09626-2
Xierali, I. M., Tong, S. T., Petterson, S. M., Puffer, J. C., Phillips, R. L., & Bazemore, A. W. (2013). Family physicians are essential for mental health care delivery. Journal of the American Board of Family Medicine: JABFM, 26(2), 114–115. https://doi.org/10.3122/jabfm.2013.02.120219
Funding
Indiana University Health.
Author information
Authors and Affiliations
Contributions
JLV contributed to the study design and implementation, data collection, guiding analysis, literature review and writing of the manuscript. MS contributed to the literature review and writing of the manuscript. EGH contributed to the study design and implementation, data collection, and guiding analysis. MB contributed to data collection and writing of the manuscript. SAL contributed to data collection and writing of the manuscript. SG contributed to data analytical design and execution of statistical procedures, as well as writing of the manuscript. FO contributed to data analytical design and execution of statistical procedures. ET contributed to data management and analysis. KM contributed to the literature review and writing of the manuscript. WK contributed to the study design, guiding analysis, and writing of the manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
Jenifer L. Vohs, Molin Shi, Emily G. Holmes, Melissa Butler, Sarah A. Landsberger, Sujuan Gao, Fanqian Ouyang, Evgenia Teal, Kristen Merkitch, and William Kronenberger have no relevant financial or non-financial interests to disclose.
Ethics Approval
Yes, Indiana University IRB approval.
Consent to Participate
N/A.
Consent for Publication
N/A.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Vohs, J.L., Shi, M., Holmes, E.G. et al. Novel Approach to Integrating Mental Health Care into a Primary Care Setting: Development, Implementation, and Outcomes. J Clin Psychol Med Settings 30, 3–16 (2023). https://doi.org/10.1007/s10880-022-09882-9
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-022-09882-9