Academic Psychiatry

, Volume 42, Issue 2, pp 265–268 | Cite as

A Unified Model of Behavioral Health Integration in Primary Care

  • Mark McGovern
  • Kaitlin Dent
  • Rodger Kessler
In Depth Article: Commentary

Psychiatric conditions, including depression, anxiety, and substance use disorders are common in general medical practice, drive health care costs, and undermine positive outcomes [1, 2]. Transformational federal legislation such as the Affordable Care Act and the Mental Health and Addiction Parity Act leverage policy and financing to address behavioral health alongside and equally with physical health [3]. Aspirational health care delivery models, including the vision for population health and the patient-centered medical home, likewise embrace the values of more holistic care that are of preference to patients and families [4]. The premise for integrating behavioral health in primary care is rather simple: (1) meet patients where they seek health care; (2) identify those at risk, and offer preventative or early intervention services for emerging, mild or moderately severe problems; and (3) for those patients who have problems that are too severe or complex to manage effectively,...


Compliance with Ethical Standards

This commentary was composed and written in compliance with all ethical standards and considerations.


On behalf of all authors, the corresponding author states that there is no conflict of interest to disclose.


  1. 1.
    McGough PM, Bauer AM, Collins L, Dugdale DC. Integrating behavioral health into primary care. Popul Health Manag. 2016;19(2):81–7. Scholar
  2. 2.
    Melek SP, Norris DT, Paulus J. Economic impact of integrated medical-behavioral health: implications for psychiatry. Denver: American Psychiatric Association 2013; 2014.Google Scholar
  3. 3.
    Beronio K, Glied S, Frank R. How the affordable care act and mental health parity and addiction equity act greatly expand coverage of behavioral health care. J Behav Heal Serv Res. 2014;41(4):410–28.CrossRefGoogle Scholar
  4. 4.
    Jackson GL, Powers BJ, Chatterjee R, Bettger JP, Kemper AR, Hasselblad V, et al. The patient-centered medical home: a systematic review. Annu Intern Med. 2013;158(3):169–78. Scholar
  5. 5.
    Thielke S, Vannoy S, Unützer J. Integrating mental health and primary care. Prim Care. 2007;34(3):571–92. Scholar
  6. 6.
    Bradley KA, Ludman EJ, Chavez LJ, Bobb JF, Ruedebusch SJ, Achtmeyer CE et al. Patient-centered primary care for adults at high risk for AUDs: the choosing healthier drinking options in primary CarE (CHOICE) trial. Addict Sci Clin Pract 2017;12(1):15.
  7. 7.
    Coventry PA, Hudson JL, Kontopantelis E, Archer J, Richards DA, Gilbody S, et al. Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials. PLoS One. 2014;9(9):e108114. Scholar
  8. 8.
    Oud M, Mayo-Wilson E, Braidwood R, Schulte P, Jones SH, Morriss R, et al. Pyschological interventions for adults with bipolar disorder: systematic review and meta-analysis. Br J Psychiatry. 2016;208(03):213–22. Scholar
  9. 9.
    Muntingh AD, van der Feltz-Cornelis CM, van Marwijk HW, Spinhoven P, van Balkom AJ. Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis. BMC Fam Pract. 2016;17(1):62. CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, brief intervention, and referral to treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007;28(3):7–30. Scholar
  11. 11.
    Lagisetty P, Klasa K, Bush C, Heisler M, Chopra V, Bohnert A. Primary care models for treating opioid use disorders: what actually works? A systematic review. PLoS One. 2017;12(10):e0186315. Scholar
  12. 12.
    Milossevic I, Chudzik SM, Boyd S, McCabe RE. Evaluation of an integrated group cognitive-behavioral treatment for comorbid mood, anxiety, and substance use disorders: a pilot study. J Anxiety Disord. 2017;46:85–100. Scholar
  13. 13.
    McGovern MP, Lambert-Harris C, Xie H, Meier A, McLeman B, Saunders E. A randomized controlled trial of treatments for co-occuring substance use disorders and PTSD. Addiction. 2015;110(7):1194–204. Scholar
  14. 14.
    Scott C, Mendez-Shannon CE. Behavioral health provider essentials. Integrated care: a guide for effective implementation. Arlington: American Psychiatric Association Publishing; 2017. p. 91–125.Google Scholar
  15. 15.
    Reinert DF, Allen JP. The alcohol use disorders identification test: an update of research findings. Alcohol Clin Exp Res. 2007;31(2):185–99. Scholar
  16. 16.
    McNeely J, Strauss SM, Wright S, Rotrosen J, Khan R, Lee JD, et al. Test-retest reliability of a self-administered alcohol, smoking and substance involvement screening test (ASSIST) in primary care patients. J Subst Abus Treat. 2014;47(1):93–101. Scholar
  17. 17.
    Hildebrand M. The psychometric properties of the drug use disorders identification test (DUDIT): a review of recent research. J Subst Abus Treat. 2015;53:52–9. Scholar
  18. 18.
    McGovern MP, Urada D, Lambert-Harris C, Sullivan ST, Mazade NA. Development and initial feasibility of an organizational measure of behavioral health integration in medical care settings. J Subst Abus Treat. 2012;43(4):402–9. Scholar
  19. 19.
    Khayal IS, McGovern MP, Bruce ML, Bartels SJ. Developing an integrated behavioral health system model using engineering design. Paper presented at Industrial and Systems Engineering Conference, May 23, 2017, Pittsburgh, PA.Google Scholar
  20. 20.
    Reiss-Brennan B, Brunisholz KD, Dredge C, Briot P, Grazier K, Wilcox A, et al. Association of integrated team-based care with health care quality, utilization, and cost. JAMA Intern Med. 2016;316(8):826–34.Google Scholar
  21. 21.
    Lasky GB. Organizational leadership and culture change. Integrated care: a guide for effective implementation. Arlington: American Psychiatric Association Publishing; 2017. p. 37–59.Google Scholar
  22. 22.
    Lasky GB. Team development and culture integrated care: a guide for effective implementation. Arlington: American Psychiatric Association Publishing; 2017. p. 61–87.Google Scholar
  23. 23.
    van Eeghen C, Kessler R, Littenberg B. Chronic care coordination by integrating care through a team-based, population-driven approach: a case study. Transl Behav Med. 2018;in press.Google Scholar
  24. 24.
    Raney L. The evolving role of psychiatry in the era of health care reform. Psychiatr Serv. 2013;64(11):1076–8. Scholar
  25. 25.
    Solberg LI, Crain AL, Jaeckels N, Ohnsorg KA, Margolis KL, Beck A, et al. The DIAMOND initiative: implementing collaborative care for dpression in 75 primary care clinics. Implement Sci. 2013;8(1)
  26. 26.
    Peek CJ, The National Integration Academy Council. Lexicon for behavioral health and primary care integration: concepts and definitions developed by expert consensus. Rockville: Agency for Healthcare Research and Quality; 2013. Accessed 9 Jan 2018.
  27. 27.
    Cacciola JS, Alterman AI, Dephilippis D, Drapkin ML, Valadez C Jr, Fala NC, et al. Development and initial evaluation of the brief addiction monitor (BAM). J Subst Abus Treat. 2013;44(3):256–63. Scholar
  28. 28.
    Watkins KE, Ober AJ, Lamp K, Lind M, Setodji C, Osilla KC, et al. Collaborative care for opioid and alcohol use disorders in primary care: the SUMMIT randomized clinical trial. JAMA Intern Med. 2017;177(10):1480–8. Scholar
  29. 29.
    Korthuis PT, McCarty D, Weimer M, Bougatsos C, Blazina I, Zakher B, et al. Primary care-based models for the treatment of opioid use disorder. Ann Intern Med. 2016;Google Scholar
  30. 30.
    CT LB, Han SC, Bergeron A, Samet JH. Office-based opioid treatment with buprenorphine (OBOT-B): statewide implementation of the Massachusetts collaborative care model in community health centers. J Subst Abus Treat. 2016;60:6–13. CrossRefGoogle Scholar
  31. 31.
    Nordstrom BR, Saunders EC, McLeman B, Meier A, Xie H, Lambert-Harris C, et al. Using a learning collaborative strategy with office-based practices to increase access and improve quality of care for patients with opioid use disorders. J Addict Med. 2016;10(2):117–23. Scholar

Copyright information

© Academic Psychiatry 2018

Authors and Affiliations

  1. 1.School of MedicineStanford UniversityStanfordUSA
  2. 2.School of the Science of Health Care DeliveryArizona State UniversityPhoenixUSA

Personalised recommendations