Integrating Mental Health and Primary Care

The practice of colocating a mental health provider in a primary care setting is being eclipsed by a new model that calls for fully integrating the disciplines.

This article first appeared in the September 2014 issue of HealthLeaders magazine.

Ten years ago, Cambridge Health Alliance, an integrated safety-net health system and teaching hospital for Harvard and Tufts medical schools, based in Cambridge, Massachusetts, believed the best way it could help its primary care providers with their patients' mental health issues was by colocating a mental health provider inside CHA's primary care practices.

The mental health providers, either psychologists or licensed clinical social workers, spent 10%–20% of their time among CHA's 15 primary care offices. With this shared resource across the practices, CHA's primary doctors had someone who could take care of their patients' mental health needs.

At the time, colocation was seen as a win-win situation, not only at CHA, but at other health systems. The hope was that colocation would solve the frequent problem that pops up with patients who have mental health needs: poor follow-up—that is, patients who seek initial help from their family doctor, yet never make it to a mental healthcare provider despite being referred to one.

With colocation, primary care physicians had someone to refer patients to quickly, often down the hall or next door, and patients could return to the familiar setting of their primary care office for mental health help, thereby reducing the stigma often associated with mental illness. While CHA found some benefits from the colocation model, it turned out to be a short-term fix for the long-term issue of mental health.