Introduction

In Philadelphia, as well as across America, access to behavioral health care is not commonly offered in a primary care setting. This can create a number of obstacles for the patient receiving treatment.

Take Joel, for example, a 50-year-old African-American man. He arrived at a community health center in 2009. He did not know what he needed to be treated for, but said that he “just didn’t feel right.” Joel has had several chronic medical issues, and throughout this visit it became clear that he also had issues with memory loss and anxiety. He was afraid of having any lab work done and did not want to see any specialists.

Had Joel arrived at the health center a few years ago, no systems would have been in place to respond to and treat his behavioral health issue. Said his primary care provider (PCP), Joel “would have been presented to me and I would have referred him to neuro again and again.” Even if a referral had been made, given Joel’s anxiety and fear of specialists, the likelihood that he would follow up on mental health services is extremely low.

However, because of HFP and its innovative work to integrate behavioral health services into a primary care setting, Joel’s issues did not have to go untreated. HFP’s integrated approach has been instituted within several Federally Qualified Health Centers (FQHCs) in the Philadelphia area with the aid of Community Behavioral Health, a managed behavioral healthcare organization, and the Philadelphia Department of Behavioral Health. The model fully integrates behavioral health professionals (such as psychologists, therapists, and social workers) into patient flow in busy primary care practices.

The behavioral health provider sees the patient for a highly focused assessment and intervention. Treatment is focused on negotiating behavior change and teaching symptom management to improve that individual’s functional status. The behavioral health specialist acts as a consultant to PCPs regarding treatment planning. In addition, any medication deemed necessary can be prescribed by the PCP on site. This model does not replace traditional therapy and is not appropriate for all individuals, but provides an option for those who would not otherwise have access to behavioral health care because of limited availability, stigma, cost, or other barriers.

This was the case for Joel, who happened to be visiting a community health center with the integrated model in place. When the PCP took note of the patient’s distress and anxiety, he called in a behavioral health specialist. The specialist provided teaching around relaxation techniques to help Joel get the lab work he needed, including a lumbar puncture, despite his fear. The specialist also worked with Joel to develop a chronic care calendar to help him organize his healthcare needs and ward against memory loss of appointments. Without the behavioral health specialist, Joel would not have received the care he needed (HFP 2009b).

The integrated model has dramatically increased access to behavioral health care for medically underserved populations by removing previous barriers such as social stigma, lack of time and money, and shortage of behavioral health specialists. In 2009, over 3,600 patients were seen under the integrated model. Conservative estimates suggest that this model saved the Philadelphia healthcare system more than $3 million that year. This represents a staggering social return on investment, facilitated by the HFP and Levkovich. HFP has successfully implemented, coordinated, and sustained this model, which some are calling the first instance of “primary behavioral health care.”