The Problem: Inadequate Behavioral Healthcare Services for Poor

Community health centers have been providing primary care to medically underserved neighborhoods for decades. Annually, more than 260,000 patients visit such centers in Philadelphia. Because of poverty or lack of insurance, many of these patients would otherwise not have access to care. Traditionally, these health clinics provide primary care and refer patients requiring behavioral health care to specialists at offsite locations.

Some experts estimate that up to 70 percent of patients have a behavioral health issue that is co-occurring with or complicating their physical health. However, most patients referred to behavioral health specialists do not subsequently seek treatment. Untreated mental health issues can lead to decreased quality of life for the patient and increased physical health problems, as well as an increased cost to the healthcare system.

However, the primary care setting is now widely recognized as the initial, and often only, opportunity for people to access behavioral health services. PCPs provide the majority of mental health care in the United States. Among one in five adults will experience a diagnosable mental health condition in any given year (U.S. Department of Health and Human Services 1999). And more than 40 percent initially seek help in primary care settings (Chapa 2004). But behavioral health services are not typically offered within the primary care setting, in either community clinics or family practices. Access to behavioral health treatment is an issue that crosses all income levels.

To add to the problem, there is a national shortage of accessible behavioral health specialists. In a recent survey of PCPs, about two-thirds reported that they could not get outpatient mental health services for patients — a rate that was at least twice as high as that for other services (Cunningham 2009).

The issue of access is heightened for low-income communities. FQHCs have been providing primary care to medically underserved neighborhoods for decades. In Philadelphia alone, thousands of people visit these community health centers. As a result of the complications and trauma of living below the poverty line in stressed communities, many low-income individuals suffer from higher rates of behavioral health issues. Left untreated, these issues can lead to an increase in other health problems and use of other health services. Studies have shown that patients suffering from mild to severe depression are two to three times as likely to seek care for physical health problems (HFP 2009a).