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Integration of Mental Health Services in Primary Care Settings

People with substance abuse issues generally benefit from an integrated system of care. This model focuses on the integration of mental health services, including substance abuse services, into primary care settings to increase access to and coordination of care for people with substance abuse issues. Individuals who suffer from substance abuse may experience co-occurring conditions, particularly lung disease, hepatitis, HIV/AIDS, cardiovascular disease, and cancer. Substance abuse can create challenges in managing other chronic diseases; evidence suggests that when substance abuse and other chronic diseases are addressed together, both conditions are more likely to improve.

Possible approaches include providing access to care for substance abuse in a primary care setting using telehealth and including mental health consultants on the primary care team. Other integrated care opportunities for treating opioid abuse can be found in Integrated Service Delivery Models for Opioid Treatment Programs in an Era of Increasing Opioid Addiction, Health Reform, and Parity. This paper describes several models including coordination with physicians prescribing buprenorphine, and coordinating with primary care providers, psychiatric providers, and specialty medical providers.

The Primary Care Behavioral Health Model of the Rural Services Integration Toolkit provides more information about this approach.

Examples of Integration with Mental Health and Primary Care

  • Verde Valley Guidance Clinic in Cottonwood, Arizona provides both primary care as well as treatment for substance abuse to women via its A Woman's World program. Services include individual and group therapy, healthcare services, crisis intervention, and an on-site pharmacy.
  • The Loyola Recovery Foundation located in Bath, New York provides substance abuse treatment services in coordination with the Department of Veterans Affairs, which provides primary care services. Major services include a detoxification center and crisis intervention services.
  • The Armstrong-Indiana-Clarion Drug and Alcohol Commission's Addiction Recovery Mobile Outreach Team (ARMOT) in Shelocta, Pennsylvania serves as a point of interception for individuals accessing emergency departments, psychiatric units, or other healthcare providers who might be in need of substance abuse services. Clients are referred to the ARMOT program via hospital staff and then a mobile case manager provides assessments and referrals based on the client's needs.
  • The Southwest Montana Community Health Center in Butte, Montana has integrated behavioral health services into its pre-existing primary care setting in order to link patients with substance abuse issues to counseling and other community programs.

Considerations for Implementation

A major challenge in seeking mental health services, particularly in small communities, is the stigma associated with mental health and substance abuse. The co-location of mental health and primary care services may help to reduce this stigma because many different types of services are available in one setting.

The integration of mental health and primary care benefits people with substance abuse issues who may have co-occurring conditions often linked with substance abuse, including lung disease, cardiovascular disease, HIV/AIDS, hepatitis, and depression and anxiety. The integration of services allows people to receive a variety of healthcare services.

When integrating substance abuse services with primary care services, additional considerations include necessary trainings, reimbursement and billing changes, and liability and confidentiality issues. For more information on these considerations, see Module 3 of the Rural Services Integration Toolkit.

Program Clearinghouse Examples

Resources to Learn More

Innovations in Addictions Treatment
Document
This guide includes a checklist for integrating substance abuse services and provides examples of integration in rural settings.
Organization(s): SAMHSA-HRSA Center for Integrated Health Solutions
Date: 5/2013

Integrated Service Delivery Models for Opioid Treatment Programs in an Era of Increasing Opioid Addiction, Health Reform, and Parity
Document
This policy paper gives an overview and recommendations on the integration of outpatient treatment programs and primary and behavioral healthcare settings in the treatment of opioid abuse.
Author(s): Stoller, K, Stephens, M, and Schorr, A.
Organization(s): American Association for the Treatment of Opioid Dependence
Date: 7/2016

Partners in Health: Mental Health, Primary Care and Substance Use Inter-Agency Collaboration Toolkit
Document
This interactive toolkit gives basic background information on service integration and includes resources such as templates, checklists, and sample agreements.
Organization(s): Integrated Behavioral Health Project
Date 2013

Substance Use Disorders and the Person-Centered Healthcare Home
Document
Provides background information and approaches to the integration of substance abuse treatment services and healthcare services, as well as policy and practice implications.
Organization(s): National Council for Community Behavioral Healthcare
Date: 3/2010