Purpose: The purpose is to demonstrate the benefits of integrating behavioral health into adult primary care and investigate the challenges and barriers of implementation.
Background: The current United States healthcare system is fragmented, limiting access to mental health services and neglecting to address comorbid diagnoses that may be present and deteriorating to many individuals. Screening for mental health and wellness is just as significant to preventative treatment as screening for common physical health problems, as both can be equally detrimental. Integrated behavioral health care is a model of patient care that is person-centered and focuses on providing mental health services in the primary care setting. This model has the potential to improve outcomes for millions of Americans that suffer from these comorbid physical and mental health problems (Grazier, Smiley, & Bondalapati, 2016). While there are barriers to integrating mental health services into the world of primary care, there are benefits that can far outweigh the challenges faced by providers.
Methods: A literature review of 45 articles was conducted to investigate the challenges, barriers, facilitators and benefits of an integrated behavioral health care model. Three databases (Pubmed, CINAHL, and MEDLINE full text) were searched with the keywords: primary care, behavioral health, integrated care, integrative health, mental health, integration, psychiatry, patient satisfaction. Relevant articles were published between 2004 and 2019. The focus of the review is on the adult population including those from low socioeconomic areas with underlying depression, anxiety, trauma, and substance use disorders.
Findings: Upon review of the literature, both the barriers and benefits of an integrated behavioral health care model were identified. Individuals with mental health disorders often present with symptoms in the primary care setting. These individuals can be identified through screening during primary care visits, and be provided with early intervention, education, and referral to treatment. Primary care providers are ill-equipped to manage complex mental health needs of these individuals, therefore when integrating behavioral health there are qualified providers available for consultation or warm hand-off. Mental and physical health are interwoven, therefore by integrating care individuals can be treated in a holistic manner and mental health services will become more easily accessible (World Health Organization, 2008). Some of the many challenges and barriers include provider resistance due to time constraints, knowledge deficits, and resistance to change. The large volume of individuals in need of mental health services and the limited number of qualified providers is a barrier to implementation of the integrated behavioral health care model. Also, financial barriers regarding state and federal policies that affect reimbursement are another significant hindrance to integrated care.
Practice Implications/Conclusion: Review of these studies clearly indicate the importance and benefits of integrating behavioral health into primary care settings. Behavioral health is based on a biopsychosocial disease model, which includes biological, psychological, and social factors when evaluating an individual’s level of wellness. Therefore, it is imperative that multiple health disciplines are involved in patient care to provide the most optimal care and promote overall wellness. A model of integrative care requires a collaborative effort from providers and a team-based approach to promote optimal wellness for patients.
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