Primary Care and Mental Health: Literature Review

The Role of Primary Care Providers in Mental Health Care: Models and Evidence

Beth Rosenshein and Anne Valentine, Institute for Behavioral Health, Schneider Institutes for Health Policy
Heller School for Social Policy and Management, Brandeis University

December, 2015

EXECUTIVE SUMMARY

The provision of quality, evidence-based behavioral health care is a significant challenge in the US and elsewhere. Findings from the National Comorbidity Survey, suggest that among US adults with a mental health disorder, only forty percent receive any type of behavioral health care (Kessler, Ciu, Deler, & Walters, 2005). Given that upwards of 26.2% of the US adult population has a behavioral health disorder in any given year (Kessler et al., 2005), the challenges of adequate service provision are noteworthy.

The recent spate of healthcare reform in the US and mental health care reform in Israel, afford numerous opportunities to assess, evaluate and learn from these reform efforts. This brief article is intended to orient the Israeli reader to ongoing efforts in US – particularly in the past decade – to develop and implement system delivery reforms in primary care settings that better integrate primary care and behavioral health. The models of primary and behavioral health integration examined in this essay exist along a continuum of options from separate settings, to co-location, to full integration of care. Evidence suggests that integration of primary care and behavioral health has the potential to enhance patient outcomes via earlier identification of psychiatric symptoms and increased access to evidence-based behavioral health services (Collins, Hewson, Munger, & Wade, 2010).

The models of collaborative or integrated care noted in this report have received a great deal of attention in the US from researchers and policymakers alike. However, important questions remain with respect to the implementation of multiple models, and which forms of integration function best, particularly within the context of managed care. The roles of primary care physicians are numerous and varied. Models of integration must pay attention to organizational and structural factors that allow for primary care physicians to draw on the strengths of their discipline while being mindful of the clinical setting, physician time constraints, skills and training.

This article examines the challenges of integrated care in the US. The multiple roles of primary care providers, the value of integrated care models, and a brief explanation of various integration models are discussed with emphasis placed on the strengths and weaknesses of each model, and the challenges of implementation within a managed care setting. A brief discussion of the relevance of the integration models for Israel’s mental health reform follows. Implementation of an integrated model of care may be helpful in addressing Israel’s desire to improve access to and quality of mental health care.