Primary Care Behavioral Health: Integrated Care Improves Health Outcomes for Service Members

photo of a man in army uniform talking to another man sitting down.
U.S. Navy photo by Ensign Courtney Avon
By Eunice Kimunai, Ph.D., MPH, RN
March 26, 2018

According to the American Hospital Association, one in four Americans experience a behavioral health illness or substance use disorder each year, and the majority of those individuals also suffer from a comorbid physical health condition. Further, approximately 60 percent of mental health care visits are with a primary care physician and almost half of patients do not follow through when referred to a mental health specialist. Fortunately there’s a Defense Department program integrated into primary care clinics to help active-duty and retired service members and their families address some of these concerns.

Primary Care Behavioral Health (PCBH) integrates behavioral health services into primary care to improve health outcomes. PCBH aims to enhance usual primary care treatment by incorporating focused evaluations, brief interventions, and care management within the primary care clinic.

We know that service members, retired service members, and their families go to primary care first for most health care services. Because primary care clinics provide general services, patients often find it less stigmatizing and easier to access services. Integrating behavioral health providers into primary care teams helps reduce patient readmission rates, improve overall satisfaction with care and improves collaboration between providers.

PCBH requires a blended model of care with two parts:

  • Primary Care Behavioral Health Model: Psychologists, social workers, or psychiatric nurse practitioners serving as behavioral health consultants within the Primary Care Medical Home provide brief assessment and intervention for a wide range of behavioral health and chronic medical problems (e.g., sleep problems, weight loss, mild depression, pain).

  • Care Management Model: Registered nurses serving as behavioral health facilitators provide telephone follow-up with patients who screen positive for depression, anxiety, and posttraumatic stress disorder (PTSD) to facilitate treatment plans, continuity and communication between patients and primary care providers.

The main team members responsible for delivering PCBH services in the DoD include the Primary Care Manager (PCM), Internal Behavioral Health Consultant (IBHC), External Behavioral Health Consultant (EBHC), and the Behavioral Health Care Facilitator (BHCF).

  • PCMs drive the treatment plan and maintain primary responsibility for the patient’s care and treatment and initiates and/or approves referrals for any specialized services.
  • IBHCs provide focused, consultative assessment and brief evidence-based/targeted interventions for a wide-range of health behaviors, behavioral health and medical problems. IBHCs are specially trained psychologists and social workers.
  • EBHCs provide consultation to PCMs as needed based on direct request from the PCM to the EBHC. EBHCs are behavioral health prescribers including psychiatrists, psychiatric nurse practitioners and prescribing psychologists.
  • BHCFs provide services that reinforce, encourage, check, and support the patient’s adherence to the treatment plan. BHCFs are usually registered nurses who have been trained to help patients who are experiencing depression, anxiety and/or PTSD.

PCBH clinical pathways were developed to help these teams provide improved collaborative care for specific mental health and chronic medical conditions frequently seen in primary care settings. Each pathway contains detailed guidance on strategies for:

1. Identifying patients for pathway inclusion (screening, provider visit, PCMH Data Pulls) 2. Connectin the patient with the IBHC 3. Intervening with evidence-based approaches from the IBHC (medication, IBHC intervention, care facilitation) 4. Monitoring outcomes of care (e.g., standard assessmen tools, systoms, labs)

Learn more about the PCBH program, connecting patients with an IBHC, and transitioning patients between primary care and specialty mental health care on the PHCoE website.

Dr. Eunice Kimunai is a contracted nurse proponent at the Psychological Health Center of Excellence (PHCoE). She has a master’s and doctorate in public health.

The views expressed in Clinician's Corner blogs are solely those of the author and do not necessarily reflect the opinion of the Psychological Health Center of Excellence or Department of Defense.

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