March 4, 2026 Forum

So I bring to you primary care behavioral health integration as a trigger topic because I think that it represents the best sort of advanced primary care you can provide. It’s not the only thing necessary to advance primary care, but it represents the primary professional relationship that I think meets the most needs of the most people in the United States. People who are seeking out and unable to find a primary care doctor or a behavioral health person who can help them because the systems are not in place to support primary care behavioral health integration. You folks have been around long enough to remember when the data first came out in the early 2000s indicating that this integration really reduces unnecessary visits to the ER for unmet mental and behavioral health needs, the largest source of unmet needs that bring people repeatedly to the emergency room and gets them hospitalized over and over again.

There’s a way to reduce that by doing primary care behavioral health integration either with a psychiatrist or a behavioral health team. There are a variety of models that were utilized, lots of interesting studies coming out from Mayo. Clinic and various other heavily renowned places concluded that this integration saves money, and improves outcomes. For example, we’ve eliminated people unnecessarily going to the ER for depression. It’s saving our system millions of dollars.

Despite all that evidence, when people on the street tried to implement and integrative program, they found it complex. In large part, I think I can speak from experience, it’s because converging the professions of behavioral health and primary health leads to a lot of interprofessional conflict and challenges of cultural nature. For example, because behavioral health predominantly cares for a stigmatized population, there’s a lot of privacy emphasis. There are serious walls around communication to the point where after years of my referring people to a therapist back at the county, I could not get that therapist even to admit to me that they’d ever seen my patient, multiple patients. I felt like I was the number one referrer. Someone finally explained that to me, that that’s part of their training. Some have told me, you have to subpoena me for me to admit that I’ve seen this person because I work in a stigmatized industry. I can’t write notes in your chart because I might have broken the glass. We have to keep secret, particularly around substance use and severe mental illness. Those are heavily protected privacy issues, and so we don’t want to write notes in your chart so you can’t read what we’ve done. We can’t tell you what we’re doing.