Need to see a mental health provider but don’t know where to start? You may be able to get connected to one through your regular doctor.
It’s becoming increasingly common to see primary care doctors getting involved with mental health care — whether by connecting patients to same-day appointments with psychologists, or teaming up with mental health providers to keep track of a patient’s mental health challenges.
The model of care, known broadly as “integrated mental health,” gives patients an entry point to behavioral health care in a setting they’re already familiar with — their own doctor’s office. Doctors can quickly refer patients to mental health treatment and can be kept in the loop about the patient’s status. The goal, mental health professionals say, is to make those services more accessible and reduce the stigma of seeking mental health care for people who otherwise wouldn’t.
“I think of us as the jack-of-all-trades Swiss Army knives of mental health,” said Rob Bailey, a psychologist with UW Medicine’s Northgate Primary Care clinic who provides integrated care. “We can do a little bit of everything, especially mild to moderate issues.”
Heather Riley, a social worker at UW Medicine’s behavioral health integration program, said these programs can be helpful for people who’ve never done counseling before.
“This is a good place to start because they trust their doctor,” she said.
Some patients say they’ve seen increased access and improved health as a result. But others say the initial connections with mental health providers haven’t translated to the long-term solutions they seek. And some have said navigating those services can be difficult depending on their insurance provider.
Providers acknowledge that these models of care are more suited toward short-term concerns. More acute or severe mental health cases are still best treated directly through specialty care, although Bailey said integrated care can still be an entry point for those types of cases.
But behavioral health professionals say that while there is room for these types of programs to grow, the core concept has already connected people to much-needed services.
“When you’re struggling with behavioral health concerns, you’re often already overwhelmed and trying to problem solve a complex system is hard,” said Anna Ratzliff, the co-director of the University of Washington’s Advancing Integrated Mental Health Solutions Center. “If you’re not sure how to get help, just go to your primary care provider and they now have more capacity to support you.”
The concept of merging physical and mental health services isn’t new. The University of Washington has been training other clinics to integrate primary and behavioral health care services for about 20 years through the Advancing Integrated Mental Health Systems program. The university began providing those services at its own clinics about a decade ago.
One model of integrated mental health care does “warm handoffs,” offering patients direct and immediate consultations with a mental health professional when they go to their regular doctor. During a checkup, doctors will ask patients if they have any mental health needs or concerns, or patients can raise those issues on their own. If so, the doctor will ask if they want to see a mental health provider that day. Patients can then have a brief appointment with a psychologist, like Bailey, who can offer an assessment and give them some immediate strategies.
Others, he said, have incorporated telehealth, where a psychologist may not be on staff, but can contract with a primary care provider to help. Some behavioral health clinics also offer assistance in the other direction — connecting patients with primary care clinicians during their appointments.
Working in tandem
The collaborative care model, which was developed at UW, involves psychiatric providers working in tandem with primary care providers and a behavioral health manager, keeping track of the patient’s mental health and progress over time.
The behavioral health integration program refers patients to social workers like Riley, and typically focuses on helping patients with moderate depression or anxiety. She offers cognitive and dialectical behavioral therapy, as well as problem-solving skills, to help patients develop coping skills.
Mara Page, a Seattle resident, said she was first offered mental health care through her primary care provider in 2022, when she went for an annual checkup at her doctor’s office, Swedish Medical Center’s Ballard clinic.
She mentioned she was experiencing some stress at work, and her doctor told her the clinic had several resident doctors specializing in behavioral health. The doctor asked if she wanted to see one, and she was able to schedule the appointment through the same office.
“It felt very unintimidating,” she said. “It was the same location I was already going to. I felt like if I had to go to a different place, I probably wouldn’t have done it because I didn’t consider my issue to be that important.”
A few months later, she was going through a period of grief and had symptoms including loss of appetite. She met with her primary care provider, who told her if things didn’t clear up in a few weeks, she should consider talking to a behavioral health provider again.
“It was cool to have that option as a first line of remedy,” Page said.
