Integrating Behavioral Health into Primary Care: A CMO’s Perspective

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May 4, 2016

Integrating Behavioral Health into Primary Care: A CMO’s Perspective

Depression is the most common type of behavioral health illness, affecting more than 26% of the U.S. adult population.  By the year 2020, depression will be the second leading cause of disability throughout the world, behind only ischemic heart disease.  It has also been shown that behavioral health disorders, especially depression, are strongly related to many chronic diseases including diabetes, cancer, cardiovascular disease, asthma and obesity as well as risk behaviors that contribute to chronic disease e.g. physical inactivity, smoking, excessive drinking and insufficient sleep.

There is an inseparable link between behavioral health and primary care, but for too long the behavioral component of health has been ignored.  A common misunderstanding exists that behavioral health illness only affects a small number of the population, but in reality up to 60% of people receiving primary care have a behavioral health disorder.  We need to do a better job of recognizing, diagnosing and treating behavioral health disorders so that people can be more productive in the workplace and at home.  Integrating behavioral health into primary care is the best way of ensuring that people have access to the behavioral health care they need – allowing people access to services closer to their homes and avoiding the high costs associated with specialist care.  It also minimizes the stigma attached to behavioral health disorders and provides good health outcomes at reasonable costs.

According to a report released in a collaborative effort between the World Health Organization and World Organization of Family Doctors (Wonca), “Integrating mental health into primary care: A global perspective”, there are seven key reasons for integrating behavioral health into primary care:

1. The burden of behavioral health disorders is great. Behavioral health disorders are prevalent in all societies. They create a substantial personal burden for affected individuals and their families, and they produce significant economic and social hardships that affect society as a whole.

2. Behavioral and physical health problems are interwoven. Many people suffer from both physical and behavioral health problems. Integrated primary care services help ensure that people are treated in a holistic manner, meeting the behavioral health needs of people with physical disorders, as well as the physical health needs of people with behavioral health disorders.

3. The treatment gap for behavioral health disorders is enormous. There is a significant gap between the prevalence of behavioral health disorders, on one hand, and the number of people receiving treatment and care, on the other hand. Primary care for behavioral health helps close this gap.

4. Primary care for behavioral health enhances access. When behavioral health is integrated into primary care, people can access behavioral health services closer to their homes, thus keeping their families together and maintaining their daily activities. Primary care for behavioral health also facilitates community outreach and behavioral health promotion, as well as long-term monitoring and management of affected individuals.

 5. Primary care for behavioral health promotes respect of human rights. Behavioral health services delivered in primary care minimize stigma and discrimination. They also remove the risk of human rights violations that can occur in psychiatric hospitals.

6. Primary care for behavioral health integration is affordable and cost effective. Primary care services integrated with behavioral health are less expensive than psychiatric hospitals, for patients and communities. In addition, patients and families avoid indirect costs associated with seeking specialist care in distant locations.

7. Primary care for behavioral health generates good health outcomes. The majority of people with behavioral health disorders treated in primary care have good outcomes, particularly when linked to a network of services at secondary level and in the community.

In Paladina Health’s Direct Primary Care (DPC) model of healthcare, primary care is wrapped around behavioral health.  Our physicians have expertise in behavioral health and some have extended training.  We also use validated instruments to screen for anxiety and depression –we believe it’s key to a comprehensive approach to delivering primary care.

Paladina Health’s model of patient-first care focuses on our physicians building a trusted relationship with their patients – our physicians are given more time to spend with their patients.  They’re able to really get to know their patients, which makes it easier for them to talk about behavioral health concerns.  It’s important for patients to feel heard and understood.  They need to know that the person caring for them is interested in their behavioral health along with their physical self.

We can’t ignore the behavioral component of health and focus just on the physical, but not all physicians are interested in behavioral health.  There is still some stigma associated with behavioral health and sharing around concerns, often people don’t even recognize they’re depressed.   In order to build trust between a physician and patient there needs to be continuity in the relationship, but most physician practices don’t have the capacity.  Trust takes time, but it’s the element of trust that makes it easier for people to talk about all their health concerns. 

At Paladina Health, many of our physicians have expressed excitement around the additional time they’ve been given to care for people so that they can understand the behavioral determinants of health for each individual patient and address concerns before they become more complex and costly.   Our approach to healthcare, with behavioral health integrated into primary care, offers the best opportunity to comprehensively manage the full spectrum of population health.

Learn more about Paladina Health’s Direct Primary Care model and how our approach differs from traditional primary care practices.

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