Behavioral Health Services
Behavioral Health
The primary care behavioral health (PCBH) consultation model is a psychological approach to population-based clinical health care that is simultaneously co-located, collaborative, and integrated within the primary care clinic. The goal of PCBH is to improve and promote overall health within the general population. This approach is important because approximately half of all patients in primary care present with psychiatric comorbidities, and 60% of psychiatric illness is treated in primary care.
Primary care practice has traditionally adopted a generalist approach whereby physicians are trained in the medical model and solutions to problems typically involve medications, procedures, and advice. Appointment times are short, with the goal of seeing a large number of patients in a day. Many patients present with behavioral health care needs that may overlap with medical disorders and that may exacerbate, complicate, or masquerade as physical symptoms. In addition, many medical problems present with associated psychological sequelae (such as stress, emotional reactions, dysfunctional lifestyle behaviors), that are amenable to change through behavioral interventions that can improve outcomes for these health problems.
The PCBH model enables early identification and behavioral/medical intervention that can prevent some acute problems from becoming chronic health care problems (such as chronic pain, diabetes, COPD, hypertension, obesity), which are the cause of many medical visits to primary care clinics. Behavioral health consultants (BHCs) work side-by-side with all members of the clinical care team (including primary care providers (PCPs) and nursing staff) to enhance preventive and clinical care for mental health problems that have traditionally been treated solely by physicians. The role of the BHC is to facilitate systemic change within primary care that facilitates a multidisciplinary approach both from a treatment and reimbursement standpoint. BHCs typically collaborate with physicians to develop treatment plans, monitor patient progress, and flexibly provide care to meet patients’ changing needs. Moreover, the integrated care model increases behavioral health accessibility, fosters communication between patients and their primary care team, and improves patients’ experiences receiving primary care.
- Primary care psychology
- Provision of clinical mental health services through a population-based focus on the common problems confronting a majority of individuals. Such issues treated in primary care may include response to physical illness, stress, affective concerns, substance use and abuse, and developmental and situational issues among others. Primary care psychologists are co-located with primary care providers and usually share the same physical space in practice. Primary care psychologists may retain the traditional session length of specialty care or may adhere to a brief, consultative approach that is solution-focused. Primary care psychologists may often be trained in health psychology programs, but not exclusively so.
- Behavioral health consultant
- Behavioral health consultants and primary care physicians collaborate within the same system. The behavioral health provider works as part of the medical team to meet the wide range of needs with which patients present.
- Collaborative care
- This model uses databases or what are known as registries to track and monitor patients with certain conditions. Typical examples in primary care include diabetes and depression. Often the person managing the registry is a nurse or mental health professional who performs follow-up phone calls and assists the primary care team in following evidence-based protocols. There is often also a consulting psychiatrist who oversees the provision of care in primary care.
