Integrating Behavioral Health Into Your Practice

To care for the whole patient, you have to treat the body as well as the mind. Behavioral health is critical to our physical and mental well-being, but it is often overlooked and not integrated within primary care practices.

We all know that humans are creatures of habit. Our daily habits and behaviors make us who we are. When viewed holistically, the sum of our practices constructs an overarching picture of our behavioral health.

As it stands, many American citizens lack access to certified behavioral health experts. According to the Medical Group Management Association, more than half of the counties in the U.S. do not have a licensed behavioral health provider, and only six states have the recommended 14.7 psychiatry experts per 100,000 patients. This lack of behavioral health support leaves a significant gap in our healthcare system.

To offset the void in the system created by a shortage of mental and behavioral health experts, the need for integrated behavioral and primary care is more significant than ever. However, to understand how we need to integrate care, it is vital to understand the nature of behavioral health first.

What is behavioral health?

Behavioral health is how our daily cognitive habits affect our biology, behavior, emotions, and general well-being. By closely examining an individual’s behavior, health professionals can gain valuable insights into how their patients’ habits affect them holistically. For example, knowing a patient’s eating, sleeping, and exercise habits can influence how physicians treat issues such as weight loss.

From regular exercise to practicing good oral hygiene, the things we repeatedly do can quickly become habits. In many cases, creating habits takes conscious, repetitive actions that slowly become automatic decisions over time.

You can create healthy habits that direct you toward a place of ideal mental and physical balance, such as maintaining a proper diet or choosing to take a daily multivitamin. Conversely, you can also form negative habits that keep you from becoming your best self, like tobacco use, alcohol use, or social isolation.

In addition to physical manifestations of behavioral patterns, patients may also display signs of mental distress due to behavioral health disorders. Recent studies show that nearly 20 million Americans suffer from substance misuse disorders, one of the most prevalent behavioral disorders, and roughly one-third of the population potentially meet the criteria for behavioral health disorders.

Behavioral health issues also affect a wide range of ages. Studies conducted by the National Center for Biotechnology Information show that half of adults with behavioral health disorders first experienced symptoms by 14. Almost three-quarters reported that they encountered their conditions by 24. Furthermore, the APA also found that 25% of adults over 55 have a mental illness, and two-thirds of nursing home residents show signs of either cognitive or behavioral problems.

Despite the prevalence of poor behavioral health in America, many patients go without treatment for their problems. Only one in ten adults struggling with substances elect to seek treatment.

The differences between behavioral health and mental health

Many times, people use the terms “behavioral health” and “mental health” interchangeably. Although they cover similar facets of a person — including how we interact with ourselves and others — these two elements of health differ. Mental health and behavioral health are related fundamentally, but behavioral health covers a much broader spectrum than mental health alone.

In general, mental health covers an individual’s well-being related to their behavior, biology, and environment. Mental health covers how the mind perceives the outside world and how people react based on their mental state. Depression, anxiety, bipolar disorder, and many other mood disorders fall under mental health disorders and attention deficit disorders.

As mental health disorders manifest themselves in outward actions, they gain behavioral health classifications. On many occasions, behaviors such as sleep issues, problems maintaining relationships, self-harm, and substance misuse stem from underlying mental issues. Because of their interrelated nature, it is crucial to analyze the behavior and the possible underlying causes.

However, it is essential to note that some behaviors may not manifest underlying mental health disorders and could result from other factors. External stresses from work or family pressure could also influence behaviors that negatively affect a patient’s life. Though these problems may be enough to promote changes in behavior, they are not necessarily rooted in mental health problems.

Physicians must educate themselves on mental and behavioral health issues to integrate strategies for treating their patients’ physical, behavioral, and mental health concerns.

Three types of behavioral health integration

Integrating behavioral health services into primary care is necessary to address behavioral health concerns and better serve patients. This integration opens opportunities for patients to have candid conversations with their trusted primary care physician about potentially harmful behaviors without the pressure of seeking out a mental health expert immediately. As a result, patients and physicians gain holistic insight into the patient, which results in better clinical outcomes and patient satisfaction.

Here are 3 of the most common forms of behavioral health integration within primary care:

• Coordinated Integration. The first level of integration is the most separated form of medical and behavioral treatment collaboration. In this system, primary care providers and behavioral specialists work in separate facilities and maintain independent records. Because of this distance, providers have limited communication with one another unless they need detailed information about a mutual patient.
• Co-located. The co-located treatment model incorporates PCPs and behavioral providers in the same facility or practice. Even though the providers work in the same area, they primarily function independently of one another. The proximity means collaboration is more likely. However, PCP and behavioral provider interactions are still rare.
• Fully integrated. When PCPs and behavioral experts participate in a fully integrated behavioral care model, they function together as a team. The primary care and behavioral specialists acknowledge the different roles and work together to provide the best care possible for patients. In this method, both providers and patients view the operation as one system designed to treat the individual holistically.

Although fully integrated systems may seem like the best possible outcome for care providers, healthcare teams need to consider the way their members interact and how significant changes run the risk of harming performance. Combining different methods until you find the best possible solution for your facility is the best way to find the right level of integration.

The importance of integrating behavioral health

Even if your healthcare facility does not explicitly state an integrated behavioral health strategy, the chances are high that you have already incorporated some form of behavioral health analysis. According to the AAFP’s FPM journal, 75% of primary care appointments include behavioral health components. From asking questions about patients’ chronic disease management to the impact of stress, diet, and exercise on their health, behavioral health analysis exists in regular appointments.

When PCPs realize the importance of integrating behavioral health and choose to incorporate it into routine appointments, it provides 7 profound benefits for patients:

1. Full Care Management. Physicians who integrate behavioral health treatment into traditional appointments acknowledge the importance of both physical and mental health. Rather than only shining a light on physical solutions, full Care Management platforms focus on the holistic nature of patients.
2. Reducing stigma. Most of the time, people are afraid to admit they need to seek help due to stigmas around mental health. Patients feel more comfortable speaking about behavioral health issues when they arise in the primary care setting — making cognitive and behavioral treatments more accessible.
3. Filling care gaps. Many areas of the country lack a proper behavioral support system, including behavioral specialists and facilities. PCPs can fill in that gap by providing behavioral health aid directly.
4. Improve patient outcomes. Many patients with behavioral health issues have positive outcomes when receiving treatment in a primary care setting. This positive increase is particularly true when patients connect to a network of specialty care services in their community.
5. Improve depression scores and lower risk of self-harm. Depression and self-harm plague millions of patients in the United States. Primary care facilities that support patients with behavioral disorders decrease the risk of self-harm and suicide.
6. Provide long-term value. Treating behavioral disorders in patients tends to be more cost-effective for care facilities in the long run due to reduced costs in treating physical side effects.
7. Quicker diagnosis and outcomes. Taking a holistic approach to healthcare moves away from the narrower idea that illness and physical side effects exist solely due to physical issues. A proper diagnosis of behavioral health issues alleviates physical side effects in many cases.

The millions of Americans living with behavioral issues stemming from depression and other mental disorders need to receive the proper amount of support. Primary care physicians can fill in the gaps left by a shortage of behavioral specialists and offer solutions to help patients heal more than their physical bodies.

Integrating behavioral health into your practice

Before including behavioral health solutions into your practice, you should consider the different factors involved with integration. When creating a sustainable behavioral health program, consider these three critical points of integration — structural integration, financial integration, and care team integration.

• Structural integration. Combining behavioral health treatment into the primary care setting requires focused administrative attention. To promote the best care possible, it is necessary to restructure your administration to collaborate across the primary care and behavioral disciplines.
• Financial integration. When choosing to integrate physical and behavioral care, securing the proper resources is vital to success. Be sure to structure your budget in a way that takes a whole-person approach to meet your patients’ needs.
• Care team integration. Initially, your practice may not be ready to take on patients’ mental and behavioral needs. That is why it is necessary to consider where you may need support and add more care professionals to your team who specialize in behavioral health.

In addition to considering different aspects of integration, one of the best ways to incorporate behavioral health assistance is to have a behavioral health consultant (BHC) on staff. The aid of a BHC helps primary care physicians look for solutions to patient issues outside of typical treatment, as seen in this case study:

• Traditional treatment strategy. Tom is a 50-year-old male who struggles with excess stress at work. He frequently experiences stress-related headaches that cause him to leave work early. You offer him two options: a prescription for medication to reduce chronic headaches or speak to a therapist about his stress levels. Before his therapy appointment date, Tom requests that you prescribe medicine to solve the issue right away.
• Integrated behavioral health strategy. After speaking with Tom about his frequent headaches and determining they stem from stress at work, you ask your BHC to drop in for a short conversation with him about his issues. Your Behavioral Health Consultant offers Tom solutions for managing stress, including deep breathing exercises, and helps him determine the triggers of his headaches. Tom and your BHC work together over a few months to continue stress management techniques and adjust his diet to support the stress management exercises. These techniques reduce his headaches, providing a solution without medication.

Offering the best patient care

Integrating behavioral health with primary care promotes a holistic approach to patient care that breaks down stigmas and fills in the gaps left by an overwhelmed mental health system. As your practice begins to add administrative processes and behavioral health consultants, your healthcare facility must remain organized. One essential resource for this integration process is a well-designed Care Management platform.

Welkin is an easy-to-use platform that simplifies your team’s patient interaction. It promotes a higher level of patient engagement and positive outcomes and includes automation, care coordination, scheduling, and security. Care Management software allows care coordination between primary care physicians and behavioral health teams and gives them the ability to track, monitor, and collaborate on patient care plans. Visit our Care Management page to learn more about how our platform could benefit your team.