Models of Integrated Behavioral and Mental Health in Primary Care

Common mental health conditions, such as depressive and anxiety disorders, are prevalent in geriatric care settings. Moreover, even mild presentations of such conditions may impart a significant burden on patients, including distress, functional impairment, reduced quality of life, and increased risk for a host of physical and cognitive health complications. Primary care remains the de facto mental health care system in the United States, with primary care providers increasingly called upon to manage a range of behavioral health conditions. Provider burden, time constraints, and patient complexity create obstacles toproviding quality comprehensive care in already strained primary care settings. The move to integrate behavioral health care into primary care is an efficient and accessible way to address the Triple Aim of healthcare by improving patient outcomes, improving population health, and reducing healthcare costs. Two major models of integrated care are the collaborative care model (CoCM) and the primary care behavioral health (PCBH) model. These models are increasingly implemented and disseminated, with particularly robust evidence and relevance for use with geriatric populations. CoCM and PCBH aim to reduce provider burden and improve the quality of care for older adults by utilizing an interprofessional team-based approach of providers. This chapter presents the core components of CoCM and PCBH and reviews the typical process of CoCM and PCBH interventions, illustrated by a case of an older patient with depression and complex biopsychosocial needs. These integrated models are effective systems-level interventions for older adults with complex healthcare needs and multimorbidity and they provide greater access to mental health care. Relevant empirical findings and implications for caregivers and communities are presented, along with further resources for training and clinical practice.