Behavioral health screening and treatment is becoming part of primary care

Email This Page

Catching mental health and substance use problems early and making short-term treatment available right in our clinics is the objective of Kaiser Permanente Washington’s Behavioral Health Integration (BHI) initiative, says Larry Marx, MD, medical director of Behavioral Health Support Services.

The BHI initiative was introduced as a pilot program at three of our Puget Sound area clinics in 2015 and was so successful that it’s gradually being extended to all of our primary care locations. The process is expected to be completed by the end of 2018.

Too often, common mental health issues such as depression and anxiety, or unhealthy alcohol or drug use, go unnoticed and untreated unless the patient experiences a crisis or initiates a discussion with their primary care provider.

“By embedding a brief behavioral health screening questionnaire into the standard work of primary care, we are able to identify people who are significantly at risk and provide real-time intervention,” says Dr. Marx.

Examples include a woman who came in for a routine office visit and was found to be acutely suicidal; a young man with a long history of heavy alcohol abuse who recognized that he was in need of treatment; and a patient with poorly controlled diabetes whose questionnaire revealed that she was drinking heavily.

“Our goal is to have one or more licensed clinical social workers on staff at each clinic, ready to meet with patients right away if needed to discuss treatment options,” says Dr. Marx. Short-term assistance provided by social workers may include one to six in-clinic visits, referral to a support group, or resource materials. If additional help is needed, patients may be referred to our Specialty Behavioral Health Services at another location.

“Making behavioral health care a normal part of a primary care visit is a great way to begin destigmatizing mental health and substance use issues, and we’re hearing from patients that they appreciate this expanded service,” says Dr. Marx.

Multiple Kaiser Permanente departments and the Kaiser Permanente Washington Health Research Institute (KPWHRI) are collaborating on implementing the new model of care and evaluating its success. Funding partners include the Agency for Healthcare Research and Quality, the KPWHRI Development Fund, the Group Health Foundation’s Partnership for Innovation, and the National Institute on Drug Abuse.