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Rural Health Information Hub

Integration into Primary Care

Primary care integration is an important model for rural communities because:

  • The current provider shortage makes access to care difficult for rural residents.
  • Primary care realizes the importance of patients having easy access to mental health services and the importance of mental healthcare to overall wellness.
  • The integration allows a warm and sometimes immediate handoff to mental healthcare providers if they are located in the facility.

Recently, many rural clinics have begun integrating mental health services into primary care facilities.

The Substance Abuse and Mental Health Services Administration and Health Resources and Services Administration's Center for Integrated Health Solutions describes the 6 levels of integration that can occur with primary care providers:

  • Level 1 – Minimal Collaboration
    In this level, mental health and other staff work in different buildings with separate integration systems and minimal communication between each other.
  • Level 2 – Basic Collaboration at a Distance
    Though providers also have separate information systems and buildings in this level of care, mental health and other providers communicate about patients through various methods such as phone calls.
  • Level 3 – Basic Collaboration Onsite
    Mental health and other healthcare workers share a building but have separate information system. Closer-proximity allows providers to communicate in-person.
  • Level 4 – Close Collaboration with Some System Integration
    Mental health and other providers share the same building and share some of the same systems. They coordinate care plans and have in-person meetings regarding patient care.
  • Level 5 – Close Collaboration Approaching an Integrated Practice
    Mental health and other providers function as a team and share the same space and many of the same systems. They have frequent communication, but may not have a fully integrated medical record system or other systems in place to be fully merged.
  • Level 6 – Full Collaboration in a Transformed/Merged Practice
    In this level, mental health and other providers share the same building, system, and understanding of patient needs. Providers of all kinds work together to deliver the best care to patients. Providers and patients view the system as one single entity.

A World Health Organization editorial in Mental Health in Family Medicine highlights that integration can lead to improved access to care and health outcomes. The editorial further recommends:

  • That policy, plans, and laws are built to strengthen primary care and develop integration with mental healthcare. An example of this is ensuring mental health parity laws are followed, meaning that physical and mental health needs are equally available and affordable to patients.
  • Healthcare organizations should offer trainings for primary care providers, so they can learn to effectively screen and treat mental health conditions.
  • For complex cases, especially involving serious and persistent mental illness, mental health specialists should also be available if primary care providers have questions or need advice on a particular case.

Rural primary care facilities can increase access to mental health services by integrating mental health treatment into primary care visits.

Program Clearinghouse Examples

Resources to Learn More

Academy for Integrating Behavioral Health and Primary Care
Provides a platform for information regarding behavioral health integration.
Organization(s): Agency for Healthcare Research and Quality

Integrating Mental Health into Primary Care
Highlights important considerations and recommendations for integrating mental health and primary care.
Author(s): Funk, M., Saraceno, B., Drew, N., & Faydi, E.
Citation: Mental Health in Family Medicine, 5(1), 5-8
Date: 3/2008