Behavioral Health and Primary Care: The Alo and Avance Care Integration Model

The numbers behind our nation’s mental health crisis tell a grim story: Over 28 million Americans going untreated. (1) One in 10 adults with mental illness uninsured. (2) Nearly 19% of young adults experiencing a major depressive episode. (3)

It can be disheartening to the two of us as behavioral health professionals. We got into this line of work because we wanted to help patients in need. To see so many who need care but, for whatever reason, cannot get it, points to the challenge we face in improving access to behavioral health services.

But these facts about behavioral health are only part of the story. The flip side is that while these challenges persist, more healthcare organizations are equipping themselves to provide better, more accessible, more coordinated care through what’s known as integrated care.

Integrated care is an idea that’s been around for decades. Simply put, it gets primary care and behavioral health on the same page. Unfortunately, it has proven challenging to implement - a common ailment in the complex system of care we’re familiar with in the United States. The medical profession still has a long way to go to fully embrace the concept and put it into practice. But we’re making progress.

Whole-Person Care When It’s Needed

In our experience, which includes providing behavioral health care in a variety of settings, nothing can match integrated care for its ability to offer patients the care they need, when they need it, without hassles and delays.

Integrated care gives patients new and more ways to engage with their doctors, both primary care and behavioral health. It also enables clinical staff to provide whole-person care - no longer splitting apart mental health from physical health.

In the eight years since Avance Care added behavioral health to the services offered to patients in North Carolina, the integration of primary care and behavioral health has been one of our highest priorities. This approach at Avance Care offices, fully supported by Alo, has several key features, including:

Ease of access. Patients have two major entry points for behavioral health. Existing primary care patients can see a mental health professional whenever needed, and new patients without an existing relationship with Avance Care can start with behavioral health. These include licensed therapists as well as psychiatrists who can prescribe medications.

Coordination and communication. Often unseen by patients, there are countless conversations between primary care clinicians and behavioral health staff that result in better coordination of care. For example, if a primary care physician has just seen a patient who might need mental health services, that doctor can pop into a behavioral health provider’s office, get them on the phone right away without going through a gatekeeper, or stop them in the hallway to determine the most appropriate path for care.

Normalizing behavioral health. Integration with primary care helps reduce both the stigma and the burden associated with seeing a mental health provider. Many behavioral health clinicians and counselors are in the same location as primary care, which makes it more of an ordinary trip to the doctor for patients than a special, perhaps inconvenient effort.

Dr. Craig White and Dr. Sashalee Stewart discuss this importance of integrating mental health services within primary care.

Meeting a Growing Need

In our work seeing patients, we get an up-close view of how the integrated care approach puts the focus where it belongs - on patient care. Integrated care also gives our clinical and administrative staff a more rewarding way of working than the traditional methods of separating physical and mental health.

We’re continuing to monitor our progress, track outcomes and patient satisfaction, and make improvements where needed. The timing couldn’t be better. As more patients struggle with their mental health, it’s imperative that primary care and behavioral health providers work seamlessly to help more people get the care they need.

Daniel Hauschild, PsyD, is a licensed psychologist at Avance Care’s Behavioral Health Treatment Center of Excellence in Raleigh, NC.

Sashalee Stewart, MD, is a board-certified psychiatrist and medical director of the Avance Care Charlotte Psychiatry practice.

Notes:

1 Mental Health America

2 Mental Health America

3 Substance Abuse and Mental Health Services Administration