Evolving Models of Integrated Behavioral Health and Primary Care

  • Parashar RamanujEmail author
  • Erin Ferenchik
  • Mary Docherty
  • Brigitta Spaeth-Rublee
  • Harold Alan Pincus
Public Policy and Public Health (G Norquist, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Public Policy and Public Health


Purpose of Review

Mental and physical disorders commonly co-occur leading to higher morbidity and mortality in people with mental and substance use disorders (collectively called behavioral health disorders). Models to integrate primary and behavioral health care for this population have not yet been implemented widely across health systems, leading to efforts to adapt models for specific subpopulations and mechanisms to facilitate more widespread adoption.

Recent Findings

Using examples from the UK and USA, we describe recent advances to integrate behavioral and primary care for new target populations including people with serious mental illness, people at the extremes of life, and for people with substance use disorders. We summarize mechanisms to incentivize integration efforts and to stimulate new integration between health and social services in primary care. We then present an outline of recent enablers for integration, concentrating on changes to funding mechanisms, developments in quality outcome measurements to promote collaborative working, and pragmatic guidance aimed at primary care providers wishing to enhance provision of behavioral care.


Integrating care between primary care and behavioral health services is a complex process. Established models of integrated care are now being tailored to target specific patient populations and policy initiatives developed to encourage adoption in particular settings. Wholly novel approaches to integrate care are significantly less common. Future efforts to integrate care should allow for flexibility and innovation around implementation, payment models that support delivery of high value care, and the development of outcome measures that incentivize collaborative working practices.


Integrated care Collaborative care Mental health services Primary care Co-occurring conditions 



This report was supported through two grants from the Commonwealth Fund of New York awarded to the New York State Psychiatric Institute. The views expressed here are those of the authors and not necessarily those of the Commonwealth Fund.

Compliance with Ethical Standards

Conflict of Interest

Erin Ferenchik, Mary Docherty, and Brigitta Spaeth-Rublee declare no conflict of interest.

Parashar Ramanuj has received honoraria from the Institute for Healthcare Improvement not related to this work.

Harold Alan Pincus declares he is a member of the Council on Quality of Care at the American Psychiatric Association for which he receives no remuneration.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Parashar Ramanuj
    • 1
    Email author
  • Erin Ferenchik
    • 2
  • Mary Docherty
    • 3
  • Brigitta Spaeth-Rublee
    • 4
  • Harold Alan Pincus
    • 4
  1. 1.Imperial College Health PartnersLondonUK
  2. 2.Center for Family and Community MedicineColumbia University Medical CenterNew YorkUSA
  3. 3.Department of Psychological MedicineSouth London and Maudsley NHS Foundation TrustLondonUK
  4. 4.New York State Psychiatric InstituteNew YorkUSA

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