Siloed behavioral health treatment in primary care
March 7, 2023
More than half of people with mental health disorders are untreated . Those who do receive care will often seek treatment from their primary care provider (PCP) . Anxiety and depression, and the debilitating symptoms these diseases have, contribute to 70% of all primary care visits. When individuals are struggling with either depression and/or anxiety, they are most likely to seek advice and care from the doctor they trust most, if not for all, of their health-related problems. The goal of primary care providers is to ensure the positive health and well-being for their patients , alas, the current business model set for these providers leaves little resources for physicians to achieve this goal alone. As this trend persists, primary care providers weather the responsibility of often being the sole provider for uncovering, diagnosing, and treating behavioral health concerns. As a result, this places a large burden on both the primary care provider and primary care practice. Unfortunately, this undue burden on the primary care provider and the primary care practice can lead to the patient not receiving care for their depression and/or anxiety symptoms.
During a recent interview with David Paul, host of the Capital Stack, Spencer Hutchins, co-founder and chief executive officer of Concert Health highlighted the problems that arise as PCPs try to combat the mental health crisis alone.
Patients who are undiagnosed but struggling with and seriously impacted by behavioral health issues, particularly depression and anxiety may find themselves in their primary care provider’s (PCP) office more frequently. They could be experiencing a gamut of physical symptoms and unaware these symptoms may be attributed to an undiagnosed behavioral health issue. As the symptoms persist, the patient may seek primary care guidance more frequently, taxing the provider and staff who do not have the support or resources to assist.
As a PCP works to alleviate the patient’s physical symptoms, a mental health assessment may be overlooked. Without being specialized in mental health, the PCP may not recognize certain symptoms as a manifestation of depression or anxiety — leaving the patient untreated and susceptible to additional or worsening of concomitant physical and mental health issues in the future.
Some patients are aware they are experiencing behavioral health symptoms. They seek help from their PCP to avoid associating with a behavioral health specialist out of fear their family or an employer may find out. The stigma of mental health can be overwhelming and self-identifying takes tremendous courage. Unfortunately, the apprehension to express these concerns usually results in minimizing the symptoms, creating an incomplete narrative and leading to an inaccurate diagnosis.
Even though a PCP may have a working knowledge of depression and anxiety symptoms, they may feel unsure about prescribing psychotropic medications. This can lead to over or under-treatment in terms of the type and dose of medication prescribed  as well as leaving the patient uninformed. If the patient is unaware of common side effects and when they should start seeing benefits, unrealistic expectations could cause the patient to prematurely quit the medication.
The research has proven that psychotropic medication when combined with psychotherapy or collaborative care is quite effective in the amelioration of depression and anxiety symptoms. ; however, more often than not, the behavioral health treatment is outsourced which creates its own set of problems: the out-of-pocket cost to see a behavioral health specialist is expensive or not covered by insurance, there is a long wait for an appointment and the PCP is no longer included as a member of the care team. In short, outsourcing behavioral care can limit the opportunity for the patient to get the care they need.
To remedy siloed treatment, integrating behavioral health care into primary care has shown significant improvement in patient outcomes . Concert Health utilizes a Collaborative Care approach that makes it possible for patients to receive the behavioral health care they need through the primary care avenue they feel most comfortable with. This model enables providers to expand their services without placing an additional burden on provider and practice.
Discover how Concert Health partnered with CommonSpirit to increase access and reduce disparities through the Collaborative Care Model.
1Kessler RC, Berglund PA, Bruce ML, et al. The prevalence and correlates of untreated serious mental illness. Health Serv Res. 2001; 36 (6 pt. 1): 987–1007.
2Blount FA, Miller BF. Addressing the workforce crisis in integrated primary care. J Clin Psychol Med Settings. 2009;16(1):113–119.
3Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2009). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. Washington, DC: American Psychological Association.
4Behera, Basanta Kumara, et al. “Primary Health-care Goal and Principles.” PubMed Central (PMC), 19 Nov. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC8607883.
5Borowsky, Steven J., et al. “Who Is at Risk of Nondetection of Mental Health Problems in Primary Care?” PubMed Central (PMC), www.ncbi.nlm.nih.gov/pmc/articles/PMC1495467. Accessed 23 Dec. 2022.
6Cuijpers, Pim, et al. “Adding Psychotherapy to Antidepressant Medication in Depression and Anxiety Disorders: A Meta-analysis.” PubMed Central (PMC), 4 Feb. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3918025.
7McGough, Peter M., et al. “Integrating Behavioral Health Into Primary Care.” PubMed Central (PMC), www.ncbi.nlm.nih.gov/pmc/articles/PMC4845678. Accessed 23 Dec. 2022.