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Curr Psychiatry Rep. 2019 Jan 19;21(1):4. doi: 10.1007/s11920-019-0985-4.

Evolving Models of Integrated Behavioral Health and Primary Care.

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Imperial College Health Partners, 30 Euston Square, London, NW1 2FB, UK.
Center for Family and Community Medicine, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA.
Department of Psychological Medicine, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK.
New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.



Mental and physical disorders commonly co-occur leading to higher morbidity and mortality in people with mental and substance use disorders (collectively called behavioral health disorders). Models to integrate primary and behavioral health care for this population have not yet been implemented widely across health systems, leading to efforts to adapt models for specific subpopulations and mechanisms to facilitate more widespread adoption.


Using examples from the UK and USA, we describe recent advances to integrate behavioral and primary care for new target populations including people with serious mental illness, people at the extremes of life, and for people with substance use disorders. We summarize mechanisms to incentivize integration efforts and to stimulate new integration between health and social services in primary care. We then present an outline of recent enablers for integration, concentrating on changes to funding mechanisms, developments in quality outcome measurements to promote collaborative working, and pragmatic guidance aimed at primary care providers wishing to enhance provision of behavioral care. Integrating care between primary care and behavioral health services is a complex process. Established models of integrated care are now being tailored to target specific patient populations and policy initiatives developed to encourage adoption in particular settings. Wholly novel approaches to integrate care are significantly less common. Future efforts to integrate care should allow for flexibility and innovation around implementation, payment models that support delivery of high value care, and the development of outcome measures that incentivize collaborative working practices.


Co-occurring conditions; Collaborative care; Integrated care; Mental health services; Primary care


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