Researchers ponder best ways for primary care to integrate mental health care

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There is no single formula for success when physicians and other clinicians integrate mental health care into primary care.

Patients could benefit from a seamless system that treats the body and behavioral health. But researchers at the U.S. Agency for Healthcare Research and Quality (AHRQ) have found there is no single dominant approach to blending the evaluations and treatments, or to pay for them.

AHRQ has published the draft “Strategies for Integrating Behavioral Health and Primary Care: A Hybrid Review,” a 120-page analysis that catalogued 76 studies outlining 87 approaches to integrate behavioral health and primary care.

“Integration has been promoted as the means to bring together and unify healthcare screening and treatment and undo what is generally acknowledged as the artificial separation of physical and mental health,” the report said. “However, many current structures and processes of the U.S. health care system, including professional training, insurance and payment, regulatory policy, and even the offices and buildings where healthcare is provided, embody this separation.”

The report categorized the approaches in four groups based on similarities and differences in key components and behavioral health professionals such as psychiatrists, psychologists, and care managers. The four approaches include:

• Structured collaboration, adding a psychiatrist, psychiatric nurse practitioner, or psychologist, and a care manager into treatment.
• Rapid behavioral health access in primary care, offering warm introductions, warm handoffs, or same-day appointments with at least one type of behavioral health professional.
• A combination of those approaches.
• Other, with some other behavioral health professionals, but without the defining components or professions for structured collaboration or rapid access.

Conflicting organizational and professional cultures and current regulations and contracts are barriers to integrating care, while a team approach, staffing and training can work to facilitate integration.

AHRQ researchers used five questions to analyze the issue:

• What approaches have been used to integrate behavioral health and primary care?
• How effective are approaches to integrating behavioral health and primary care in different situations?
• What are the barriers to and facilitators of implementing and sustaining different approaches to integrating behavioral health and primary care?
• What reliable, valid, clinically meaningful, and/or patient-centered measures and metrics are available to monitor and evaluate integration approaches?
• How are care team member roles and their work flows defined in different approaches to integrating behavioral health and primary care?

Regarding payment, the report noted primary care and behavioral health integration “is often supported by time-limited grant funding” that covers clinician training and the hiring of behavioral health clinicians.

Because it is time-limited, sustainable funding is necessary for integration. The researchers noted that “quick fix” solutions may not lead to lasting change for medical practices or patients.

“Collaboration between clinicians in an integrated system requires further clinician time,” the report said. “Because these integration planning and integrated care activities are not billable, they constrain profitability and productivity.”

AHRQ has a public comment period open through Oct. 30 for the report. Comments can be submitted here.