PCBH and Specialty Behavioral Health

While IBHCs DO provide evidence-based treatment appropriate for a primary care setting for a wide variety of clinical problems, IBHCs MUST NOT provide specialty behavioral health treatment or carry a specialty behavioral health caseload in the primary care setting. Find a description for IBHC services on the PCBH Personnel page.

Conceptual Distinctions of Primary vs. Specialty Behavioral Health Care Models

Dimension Behavioral Health Primary Care Specialty Mental Health
1. Model of care Population-based Client-based
2. Primary customer PCM, then patient Client, then others
3. Primary goals
  • Part of primary care services
  • PCM
  • Consultation model
  • Determined by PCM preference
  • Potentially decreased
Resolve client's mental health issues
4. Service delivery Part of primary care services A specialized service, either in or out of primary care
5. Who is "in charge" of patient care PCM Therapist
6. Primary modality Consultation model Specialty treatment model
7. Team structure Part of primary care team Part of specialty MH team
8. Access standard Determined by PCM preference Determined by client preference
9. Cost per episode Potentially decreased Highly variable, related to client condition

Transitioning Patients Between Primary Care and Specialty Mental Health

Some patients seen in primary care need a higher level of care than can be provided through primary care behavioral health (PCBH) services. Primary care managers (PCMs) may refer higher acuity patients directly to specialty mental health or substance abuse clinics (either within the military health system or in the Tricare network). It is recommended, however, that PCMs first link the patient with the primary care clinic’s internal behavioral health consultant (IBHC) to help facilitate a successful transition to specialty mental health care. The IBHC can work with patients to increase readiness or willingness to access care, and assist with addressing barriers to care that may arise. If there is a significant delay in access, the IBHC may continue to meet with the patient to bridge any gaps in care. Finally, the IBHC can assist with coordination and communication by sharing relevant information with the gaining mental health care provider.

Connecting to the IBHC When a Patient Declines a Referral to Specialty Mental Health

Not all primary care patients may be willing to access specialty mental health care. This reluctance can stem from different sources, such as stigma, concerns about impact on military career, cost (Tricare co-pays for some beneficiaries), time required for treatment, lack of belief in the potential benefits of mental health treatment, or one or more of many other reasons. IBHCs can identify which barriers to accessing specialty mental health care are relevant for a particular patient. They can work with patients in one or more focused appointments to help address identified barriers and increase willingness to access care. Interventions might include education about mental health disorders and treatment, motivational interviewing, or problem solving approaches. The IBHC can continue to monitor the patient’s symptoms and assess and address suicide risk during transitions in care.