How you can integrate behavioral health in your practice

Behavioral health integration (BHI) is a way for primary care practices to address patients' behavioral and mental health needs.

It is indisputable that behavioral health conditions are detrimental to those living with them. The COVID-19 pandemic, the opioid epidemic, extreme weather events, increased gun violence, and other local, national, and global political unrest have taken a devastating toll on mental health. There is also a shortage of health care professionals in the United States, adding to the mental health crisis. Primary care practices can begin to address patients' behavioral and mental health needs through behavioral health integration (BHI).

BHI can improve quality of care and expand access to behavioral health services. Incorporating behavioral health services into primary and specialty care has many benefits, including promoting overall health; enhancing access; reducing stigma; reducing risk of self-harm and suicide; increasing positive outcomes; improving patient, physician, and other clinician satisfaction; and promoting long-term value. Practices that have integrated behavioral health have reportedly seen an immense improvement in their satisfaction and reduction in stress levels.

So how can you integrate behavioral health into primary care? Though staffing can differ from practice to practice, each person on the BHI team, such as the primary care physician, medical assistants or nurses, behavioral health specialists and care coordinators, and consulting psychiatrists, should have a clear understanding of and feel comfortable in their role. To successfully integrate behavioral health in your practice, all members of the care team should be committed to training on best practices for delivering care. It is also valuable to engage and partner with your patients by showing you are committed to their mental health and helping them understand their care plan and how it will benefit them.

Primary care clinicians can take two approaches to behavioral health treatment: prescribing medications and providing other nonpharmacological services. Psychopharmacology is the use of medications to treat mental health conditions. Waco Family Medicine developed the Waco Guide, available at for the psychopharmacologic treatment of routine and complex mental and behavioral health disorders in adults and pediatric patients, as well as for perinatal and women's mental health and substance use disorders. This guide uses evidence-based guidelines, high-impact literature, and expert opinion to develop clinical decision support tools for primary care. While it does not replace independent clinical judgment and does not apply to every clinical situation, it does guide you through various treatment options, titration schedules, and possible side effects. It is a tool designed to guide primary care physicians when access to psychiatric professionals is difficult. The Waco Guide is also available in a smartphone app.

Rather than medication, nonpharmacological services and treatments involve working with patients and families to improve habits, behaviors, and emotions that impact their health or functioning. These interventions can include mental health education, motivational interviewing, behavioral activation, mindfulness/relaxation activities, parent education, and brief cognitive behavioral therapy.

It is important to note that not all BHI models of care will meet the needs of all patients with complex mental health issues, so practices should have protocols in place to identify patients who may not benefit and provide external support. Care for every person differs, and having a mental health professional or professionals to collaborate with can allow primary care clinicians to treat a wide range of services and a variety of behavioral health conditions. Mainly, patients should feel valued and cared for no matter what type of care they are receiving.

ACP has partnered with other leading U.S. physician organizations to develop the BHI Collaborative, which promotes effective, sustainable integration of behavioral and mental health care into physician practices. The BHI Collaborative is committed to ensuring a professionally satisfying, sustainable physician practice experience and will act as a trusted partner to help physicians overcome the obstacles that stand in the way of meeting their patients' mental and behavioral health needs.

Visit ACP's Behavioral and Mental Health Integration into Primary Care Practice webpage to learn more about the Collaborative's efforts.