Integrated Primary Care In Practice
Integrated Primary Care is at one end of a continuum of ways medical and mental health practitioners collaborate (see Doherty, et. al. below). Nationwide, when patients are treated by both medical and mental health clinicians, there is collaboration between these clinicians in only a minority of cases. By locating a behavioral health provider in the site of a primary care practice some level of collaborating is almost assured. To go further, however, requires a shift in paradigm for both medical and behavioral health provider.
The shift in paradigm is from usual mental health care “parachuted” into medical settings (as Nick Cummings terms it) to primary behavioral health care as part of the medical services. Primary behavioral health care often helps physicians provide mental health care by consultation rather than having most cases referred for therapy. Primary behavioral health care is brief and problem or solution focused. Commonly the cognitive behavioral model is used, but that is not required. It is briefer, averaging about half as many visits per episode of care as specialty mental health care. It is flexible, providing patient education or case management when necessary. It can treat the body, using one of the relaxation response therapies, such as mindfulness meditation, relaxation training, biofeedback or hypnosis. It is often provided as part of pre-designed integrated protocols of care for patients with particular diagnoses. Check out the integrated protocol for depression developed by Katon and his colleagues described on the Clinical Effectiveness page