Integration of Mental Health Services in Primary Care Settings

People with substance use disorder (SUD) generally benefit from having access to an integrated system of care. This model focuses on the integration of mental health services, including substance use disorder services, into primary care settings to increase access to and coordination of care for people with SUD. The Primary Care Behavioral Health Model of the Rural Services Integration Toolkit provides more information about this approach.

Possible approaches for integration include providing access to care for SUD in a primary care setting using telehealth and including mental health consultants on the primary care team. Other integrated care opportunities for treating opioid use disorder 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.

Examples of Integration with Mental Health and Primary Care

The Armstrong-Indiana-Clarion Drug and Alcohol Commission's Addiction Recovery Mobile Outreach Team (ARMOT) in Shelocta, Pennsylvania identifies individuals who are receiving care at emergency departments, psychiatric units, or other healthcare facilities and are in need of SUD services. After hospital staff refer a client to the ARMOT program, 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 use disorders 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 SUD. 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 SUD who may have co-occurring conditions often linked with substance misuse, including lung disease, cardiovascular disease, HIV/AIDS, hepatitis, depression, and anxiety. The integration of services allows people to receive a variety of healthcare services.

When integrating SUD services with primary care services, additional considerations include necessary trainings, reimbursement and billing changes, and liability and confidentiality issues. The Rural Services Integration Toolkit provides additional information about these considerations.

Program Clearinghouse Examples

Resources to Learn More

Innovations in Addictions Treatment
Document
Offers SUD providers information on integrating SUD services with primary care through the perspectives of organizations that have experienced the integration in rural settings. Discusses the events prior to integration, and the challenges and lessons learned. Includes a provider checklist to help in the redesign supporting integration.
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
Discusses opioid addiction treatment programs (OTPs) as comprehensive treatment hubs providing new treatment options, including MAT, and integrated service delivery in primary care and behavioral health settings. Recommends effective service delivery models of OTPs as a means of improving the care offered to patients.
Author(s): Stoller, K, Stephens, M, & Schorr, A.
Organization(s): American Association for the Treatment of Opioid Dependence
Date: 7/2016