November 4, 2022 – Accessing behavioral health services in the United States is becoming increasingly difficult even as the need for such services keeps growing. Some healthcare decision-makers believe that primary care practices can help fill that void. But can they shoulder the task, given the staffing and reimbursement challenges of behavioral health?
“Integrating behavioral health with primary care aims to increase access as well as reduce the stigma associated with seeking mental health treatment,” says Sterling Ransone, M.D., FAAFP, president of the American Academy of Family Physicians. “Without a system in place to routinely screen for behavioral health conditions and substance use disorder in the primary care setting, we will miss opportunities to address problems that threaten the health and well-being of our patients, families and communities.”
Fifteen to twenty percent of adults in the United States report diagnoses of depression or mental illness, and 10% to 15% report suffering severe psychological distress in the past year, according to a recent report from the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, a Washington, D.C.-based clinical research group.
COVID-19 exacerbated the situation. Data from the U.S. Government Accountability Office shows that the pandemic increased social isolation and stress, and contributed to higher rates of anxiety and depression symptoms and increased substance use in the U.S. Yet fewer than 50% of those with a mental illness reported receiving care in the past year.
The close relationship between physical and mental health is an oft-cited rationale for integrating behavioral health and primary care. Up to 70% of all primary care visits include a behavioral health component, write leaders of the Behavioral Health Integration (BHI) Collaborative in a recent issue of “Health Affairs.” Founded in October 2021, the BHI Collaborative is led by several physician organizations and is intended to support physicians working to combine mental and physical health in their practices.
Behavioral health conditions are a leading contributor to disease burden in the United States, with depressive and substance use disorders among the top 10 causes of death and disability among adults. They are also a leading cause of preventable pregnancy-related deaths. Individuals with co-occurring physical and behavioral health conditions also tend to incur higher healthcare costs and experience worse health outcomes.
Undiagnosed and untreated behavioral health conditions often have physical manifestations, according to the Robert Graham Center. Patients with chronic diseases whose mental health conditions are left undiagnosed or untreated often experience poor management of these chronic diseases and worse clinical outcomes.