Researchers Recommend Solutions That Can Overcome Barriers To Coordinated Mental Health and Primary Care

FOR IMMEDIATE RELEASE: Thursday, May 15, 2014

Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224 

WASHINGTON — Patients in underserved, rural areas must cut through two almost-intractable barriers to get the mental health services they need, according to research in the May-June American Psychologist. As a result the chances of coordinating primary medical care and mental health services — shown to improve patient outcomes and reduce costs — are dim without funding and policy changes.

Writing in “Proximity of Providers: Colocating Behavioral Health and Primary Care and Prospects for an Integrated Workforce,” researchers reported the shortage and maldistribution of mental health professionals effectively deny access to care for millions of Americans. In addition, the current fee-for-service payment system discourages coordinated care between primary care physicians and mental health professionals. 

The analysis was completed by Benjamin F. Miller, PsyD, at the University of Colorado, Denver, School of Medicine; Stephen Petterson, PhD, research director at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, and their colleagues.

Noting that two-thirds of primary care physicians reported having no nearby mental health professional to whom they could refer patients, Miller and his coauthors studied the locations of primary care and mental health professionals’ practices. 

They found that nationwide three in 10 primary care physicians are located nearby psychologists and more than four in 10 are located near any mental health professional, including psychologists, clinical social workers, marriage and family therapists, and mental health counselors. In rural areas, however, the number of mental health professionals drops precipitously.

“It is not possible to integrate care where there are no behavioral health providers,” Miller and his co-authors write. “These shortage areas require comprehensive, long-term policies that help recruit and retain providers; or they need alternative options that are less than full integration but that bring behavioral health services to primary care settings via telemedicine or shared resources among several practices.”

Moreover, public and private insurance plans separate coverage for mental and physical health, further fragmenting services. 

“One of the most problematic issues for integrating behavioral health with primary care remains the payment systems,” the researchers write. “Consider that mental health largely remains ‘carved out’ of physical health reimbursement practices. This payment schism is a most significant policy barrier for integration efforts, but it also affects care coordination and team-based training and leads to organizational and cultural barriers.”

The authors offer recommendations to improve patients’ access to integrated primary and mental health care. Among them:

• Improve funding for and coordination of state and federal programs that provide student debt relief for mental health professionals who practice in underserved areas.
• Educate mental health students in programs that prepare psychologists and other behavioral health professionals to train and work together in primary care.
• Create and provide incentives for team-based training for medical and behavioral clinicians, including retraining opportunities for currently practicing primary care and mental health professionals whose offices are geographically close. 
• Develop and implement new payment systems — such as a per-member-per-month payment — that are not based on the number of patient visits and would enable primary care and behavioral health professionals to better integrate the care they provide.


About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.