Behavioral Health Integration to Address Substance Use Disorders

People with substance use disorders (SUD) can benefit from having access to an integrated system of care. In this model, behavioral health services, including SUD treatment, is directly integrated into primary care settings. This approach improves access and enhances coordination, which is beneficial in resource-limited rural areas as it can reduce the burden on SUD providers. It also 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.

Integrating SUD into primary care settings can take different forms. These approaches include:

Using telehealth to provide access to SUD
Including mental health consultants as part of the primary care team
Coordinating care with physicians prescribing buprenorphine
Coordinating care across primary care providers, psychiatric providers, and specialty medical providers

One example of an integrated model is the Integrating Buprenorphine Treatment for Opioid Use Disorder in HIV Primary Care intervention. This model integrates buprenorphine treatment for opioid use disorder into an HIV primary care setting. Often, the same provider prescribes both HIV treatment and buprenorphine.

The Primary Care Behavioral Health Integration Model in the Mental Health in Rural Communities Toolkit provides more information about this approach.

Examples of Rural Behavioral Health Integration Programs

Indiana's Scott County Partnership Inc. developed a one-stop shop program to provide buprenorphine, counseling, HIV and hepatitis C treatment, and primary care in a mental health clinic. The program was developed in response to an HIV outbreak traced back to syringe sharing and was the first opioid use disorder (OUD) and HIV treatment center in the rural county.
Cross-Walk, an integrated behavioral health program at Upper Great Lakes Family Health Center in Michigan, offers substance use treatment, mental health counseling, primary care, and dental services coordinated by community health workers, behavioral health case managers, and nursing staff.

Considerations for Implementation

A major challenge in seeking mental health services, particularly in small communities, is the stigma associated with mental health disorders and SUD. Co-locating mental health and primary care services may help reduce this stigma. When multiple services are available in one setting, it can make it easier to seek behavioral health support. Bringing services together can also reduce other barriers, such as transportation. Patients can receive multiple services within one visit, reducing travel time, distance, and costs.

Prior to integrating services, a program may need to consider how they will share information between providers. This may include technology solutions, such as developing a shared health record system. Programs should create an eco-map, a visual representation of a patient's care team, to depict the agencies and providers involved with and connected to the patient. This may include primary care providers, counselors, case managers, and family supports to ensure you have access to the necessary providers and services to treat patients with OUD.

When integrating SUD services with primary care services, additional considerations include ensuring necessary staff and provider trainings, reimbursement and billing changes, and liability and confidentiality issues.

Program Clearinghouse Examples

Resources to Learn More

Substance Use Resources
Website
Compiles resources for treating substance use disorders in primary care settings.
Organization(s): The Academy: Integrating Behavioral Health & Primary Care, Agency for Healthcare Research and Quality