Bringing Behaviorial Health Into Primary Care Settings

The integration of behavioral health into the primary care setting has resulted in a number of benefits. Traditionally, behavioral health and medical health operated separately, but in recent years, the integration of these two systems has improved access to care, ensured continuity of care, reduced stigma associated with seeking care and allowed for earlier detection and treatment of mental health and substance abuse issues. By bringing behavioral health specialists into primary care facilities, healthcare systems have streamlined care and brought down costs, working collaboratively and reducing the number of appointments and hospital visits.

At Carolinas HealthCare System, we use technology to take behavioral health integration one step further. A robust behavioral health integration project was developed through myStrength, using virtual and telehealth technology to ensure that every primary care practice has the capabilities for early detection of mental illness and substance abuse and upstream intervention, easing the connection between behavior health specialists and patients who might otherwise be averse to seeking professional help.

Mental illness touches each of us personally: one in five individuals struggles with mental health issues, yet access to care is one of the biggest issues facing North Carolina residents today. As of 2015, 29 out of 100 counties in North Carolina do not have a single psychiatrist and 58 out of 100 counties have a shortage of mental health services. Programs and technology that integrate behavioral health with primary care allow us to bridge the access gap and address mental health issues sooner. Our team of 25 remote providers are connected to over 70 practices, and have supported more than 8,000 patients in the past two years. Virtual teleconferencing also provides rural communities with greater and more consistent access to behavioral health treatments – an important point for a large population that often does not have the immediate ability to seek out a specialist in person.

Of the 40,000 suicides in the US last year, 64% of those people saw their primary care physician a month before taking their life, and 85% of individuals with a substance abuse or mental health disorder visit a primary care physician at least once a year. If we can integrate behavioral health into these primary care conversations – using technology to make this process even more streamlined for our strapped primary care providers – we can provide greater quality care that addresses patient needs across several access points, and get people the help they need before it’s too late.

We’ve also found that the stigma associated with visiting a behavioral health provider is reduced by coupling behavioral and medical treatments into a single appointment. Primary care physicians can connect patients to behavioral health specialists instantly during an appointment, opening new opportunities for people to seek out treatment for mental health issues. Through virtual teleconference follow-up appointments, patients can easily schedule check-ins with their behavioral health specialists, and the burden of carving out travel time from one appointment to another is reduced significantly.

The results we’ve seen from this program are remarkable: year to date, 84% of patients that had reported suicidal thoughts at the initiation of our program no longer reported suicidal thoughts at the completion of health coaching. The impact that behavioral health integration has had in our community is what makes me proud to be a part of this team. 

Innovative treatment options that help patients closer to home, allow for earlier detection of illnesses and streamline difficult conversations are what strengthen the industry’s commitment to ensuring patients are always the top priority. The implementation of services like virtual treatment capabilities not only supports access to care with a better patient experience, it also helps control costs, ensure continuity of care for patients with both behavioral health and medical diagnoses, and can enhance overall quality of care.

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2 replies »

  1. What benefit would this have on PCP’s “overprescribing” or lack of awareness/side effects around certain drugs that inherit mild psychoactive properties? I’m not talking about drugs like lithium, Paxil, Prozac, etc… that seem to fall in a licensed psychiatrist/psychologist domain. I’m referring to things like anti-depressants, anti-anxiety, ADHD and medications like diazepam derivatives, SSRI’s Adderall and other milder drugs that target your central nervous systems. The ones that produce onset psychosis conditions that the doctor never believes is actually happening. As a patient who’s been through the ringer and witnessed first hand the wreckless overprescribing of these medications by doctors, I’ve come to lose complete faith that many primary care doctors even know what the ramifications of these drugs are on patients and how many unexplained side effects often go overlooked/misdiagnosed. Often times, the doctors appear so baffled that they suggest doubling down on the medications instead of discontinuing it. Is it just me, or are PCP doctors completely unaware that some of the drugs they’re prescribing are causing more mental health conditions than they’re fixing?

  2. As an old theme, albeit neglected, what is it about Primary Healthcare that builds TRUST between each citizen and their Primary Medical (MD, DO, PA, APRN) Provider, especially for their ‘medical TRIAGE’? And if you were to assess this over time, how would you do it?