The document discusses barriers to integrating behavioral health and primary care. Some key barriers include different conceptual models between primary care and specialty mental health care, lack of provider time and training, and organizational and financial barriers between practices. Steps to improve care include adopting a problem-focused approach in primary care, clarifying roles and responsibilities between primary care physicians and behavioral health specialists, and facilitating better communication and coordination between providers.

1. Behavioral Health and Primary Care David Eisenman MD and John Luo MD Departments of Medicine and Psychiatry

8. Referral Consultative Care Collaborative Care Integrated Team Independent Autonomous (PCP) Autonomous (MHS) How

9. When Continuing Care Short-term Management Diagnosis/ Assessment Risk Factor Identification/ Prevention

11. Health Plans Money Flow and and Communication No risk Health Plan A. Indemnity Model Mental Health Plan B. Carve-out Model No Shared Risk Primary Care Provider Mental Health Specialist Legend Primary Care Provider Mental Health Specialist High communication Low communication Money Flow

13. “ Systems of care that force the separation of “mental” from “physical” problems consign the clinicians in each area of this dichotomy to a misconceived and incomplete clinical reality that produces duplication of effort, data, and ensures that the patient cannot be completely understood” Institute of Medicine, 1996