Integrating Behavioral Health Into Primary Care

Up to 75% of primary care visits include mental or behavioral health components. This includes behavioral factors related to chronic disease management, mental health issues, substance use, smoking or other tobacco use, and the impact of stress, diet, and exercise on health. Behavioral health factors have an outsized influence on morbidity and mortality, and are the source of a large portion of family physicians' frustrations with the health care system. It is common to have patients who are unable to access care for mental health or substance use due to lack of insurance coverage or access. I work in Wisconsin, where we have a relatively low percentage of uninsured patients. Still, I frequently find myself prescribing antipsychotic medications that I don't feel comfortable managing, at least until my patient can see a psychiatrist (in three months), or spending extra time during a visit doing motivational interviewing to help someone quit tobacco use.