Many patients present with behavioral health care needs that may overlap with medical disorders and that may exacerbate, complicate, or masquerade as physical symptoms.
[9] Thus, while it seems there are various "specialty" mental health clinics and psychiatrists alike, the primary care environment continues to lend itself to an array of psychiatric issues.
Examples of the frequent comorbity between medical and psychological problems include: chronic pain can cause depression; panic symptoms can lead to complaints of heart palpitations; and stress can contribute to irritable bowl syndrome.
[11] The psychosocial impact on primary care is tremendous (approximately 70% of all visits); however, it is curious that few mental health providers have traditionally placed themselves where the demand for their services is arguably the greatest.
[12] Many experts believe this low completion rate is tied to the stigma that often surrounds mental health care, causing patients to deny or refuse to seek help for psychiatric needs.
[13] As a general rule, patients who do choose to address their mental health concerns express a preference for services in primary care likely due to its familiarity and less stigmatizing environment.
The PCBH model has sought to address this dilemma by providing access to mental health services on site to more effectively target the biological, psychological, and social aspects of patient care.
BHCs also provide support and management for patients with severe and persistent mental illness and tend to be familiar with psychopharmacological interventions.
[5] Paralleling general medicine, patients who require more extensive mental health treatment are typically referred to specialty care.
BHCs tend to provide focused feedback to PCPs with succinct, action oriented recommendations to help effectively manage patients' needs.
BHC interventions tend to be more cost effective[15] and offer increased access to care, with improved patient and provider satisfaction.
[19] In general the number of empirical investigations that have examined the clinical impact and cost-offset of the BHC model is still limited, although a growing body of evidence supports the utility of other integrated behavior health programs (with varying degrees of integration) in academic settings, Veterans Affairs Medical Centers, and community health care settings.
[21] Specifically targeting depression, Schulberg, Raue, & Rollman (2002)[22] reviewed 12 randomized controlled trials (RCTs) that examined evidence-based treatments for major depression (interpersonal psychotherapy & cognitive-behavior therapy) and problem-solving therapy, compared to usual care by PCP's (i.e. antidepressant medication, drug placebo, or unspecified control).
Research also shows that providing basic training in CBT to PCPs is not enough to produce robust clinical outcomes (King et al., 2002);[24] highlighting the importance of the BHC's integrated role in primary care.
[26] The PCBH model prioritizes the usage of treatment algorithms based on scientific guidelines that include pharmacological and psychotherapeutic interventions.
Sessions are usually 50 minutes in length and the duration of treatment may vary from weeks to years depending on the mental health concern.
Typically, little contact occurs between therapists and patients' physicians or psychiatrists, and coordination of care may be difficult, time consuming, and expensive.
Behavioral health providers and PCPs practice within the same office or building but maintain separate care delivery systems, including records and treatment plans.
Typically eligible professionals for Medicaid reimbursement in federally qualified health centers include psychiatrists, psychologists and licensed clinical social workers.
Projections published by the U.S. Census Bureau estimate that by the year 2042 White, non-Hispanic people will no longer be the majority of the population in the United States.
Psychotherapy, which was offered as a prepaid benefit, was studied as a method to reduce primary care visits while also more properly (and less expensively) addressing the problem at hand.
[7] In the years to follow, behavioral health integration started to gain support from a federal level, as United States Department of Veterans Affairs (VA) systems began to conduct research around the impact of primary care psychologists, beginning with the Healthcare Network of Upstate New York (VISN2).