Background <p>Structural barriers limit timely access to specialised mental health services. Technology-based integrated care models, such as mental health specialist video consultations, connect primary care physicians, patients, and mental health specialists regardless of geographic constraints. Primary care physicians are pivotal for delivering mental health care and critical for understanding facilitators and barriers to implementing mental health specialist video consultations.</p> Objectives <p>This study aimed to (1) prospectively investigate the implementation of mental health specialist video consultations in primary care and (2) derive actionable recommendations for scalable implementation by exploring primary care physicians’ experiences through Normalization Process Theory.</p> Design <p>Mixed-methods evaluation (qualitative-primary embedded design) using semi-structured interviews, complemented by quantitative NoMAD (Normalisation MeAsure Development) questionnaire data.</p> Participants <p>Eighteen rural primary care physicians in Germany.</p> Approach <p>Thematic analysis guided by Normalization Process Theory (<i>Coherence</i>, <i>Cognitive Participation</i>, <i>Collective Action</i>, <i>Reflexive Monitoring</i>). NoMAD data were analysed using descriptive statistics.</p> Key Results <p>Narratives and high NoMAD scores indicated clear understanding of mental health specialist video consultations as delivering low-threshold, immediate support regardless of regional barriers (<i>Coherence</i>), and confidence in the suitability of on-site delivery within primary care, particularly for patient safety (<i>Cognitive Participation</i>). However, participants emphasised the need for adequate resources—space, staff, and streamlined workflows—to minimise burden on practice routines (<i>Collective Action</i>). Physicians highlighted the benefits of mental health specialist video consultations, including reduced workload, improved patient outcomes, and overall relief for the health system (<i>Reflexive Monitoring</i>).</p> Conclusions <p>Mental health specialist video consultations are a promising practical tool for integrating mental health services into primary care, with primary care physicians central to its success. However, addressing structural barriers at the practice and system levels is crucial for embedding mental health specialist video consultations into routine workflows.</p> Trial Registration <p>ClinicalTrials.gov (NCT04316572). Prospectively registered on 20 March 2020.</p>