Integrating Mental Health into Primary Care

The call for behavioral health integration into primary care has recently been renewed (New Freedom Commission on Mental Health, 2003; U.S. Department of Health and Human Services, 1999).The national Pediatric and Psychiatric Associations and the U.S. Prevention Services Task Force have recommended universal screening for depression. In addition, the Joint Commission (JCAHO) now requires suicide screening for youth with psychiatric diagnoses in inpatient and ambulatory services. Yet, despite these recommendations progress has been limited. Barriers to behavioral health integration include lack of physician training, inadequate screening tools, and difficulty helping patients access behavioral health services. Consequently, there are likely many missed opportunities for early identification of youth at high risk for suicide, depression and violence.

To address these barriers, we have developed and tested the BH-Works program, a web-based system for mental health screening, prevention, and triage, in primary care and emergency room settings. The BH-Works Program consists of provider education, web-based screening, and assistance with building a stronger behavioral health “neighborhood.”  At the core of BH-Works Program is the Behavioral Health Screening (BHS) assessment tool, a web based, comprehensive screening tool that targets thirteen different behavioral health domains in 7 to 10 minutes. These domains cover all the best practice recommendation from the AAP for a wellness visit including depression, substance abuse, trauma and suicide.

The program has been operational for 5 years across 12 counties in Pennsylvania.  Over 20,000 patients have been screened in 4 Emergency rooms and 25 primary care practices.  Findings indicate the 4.2% of patient report current suicidal ideation, and 18% report current severe depression. Of those with current ideation, 30% were in treatment, 40% were referred for treatment and 30% refused a referral. Of those with current suicidal ideation, 12% reported having access to a gun in their home.  Other psychopathology data will be presented as well as the barriers and solutions to implementing a screening program in primary care.