Behavioral health has historically taken a back seat to physical health, despite depression and related behavioral health conditions being major risk factors for chronic medical illness.

While there have been policy and clinical successes in efforts to integrate behavioral healthcare into the primary care setting, the best way to support people getting and staying in treatment remains unclear. However, a new study published in Psychiatric Services may offer some answers.

The study compares two common models: co-location and collaborative care. In a co-located model, patients are screened by their primary care doctors, and are then referred to a behavioral health provider in the same physical practice. In a collaborative care model, a care manager and/or social worker, psychiatrist and primary care provider work together as a team to create and refine treatment plans with patients.

“In Montefiore’s collaborative care model, we routinely measure patient’s depression symptoms and have contact with patients between visits,” said Michelle Blackmore Ph.D., project director, Montefiore Health System’s Care Management Organization (CMO) and primary author on the study. “We believe these elements were key to people responding better to collaborative care.”

In 2013, Montefiore began offering behavioral health services in its primary care sites to increase access to counseling and reduce stigma. Its pioneering approach to care has led to national recognition and grants from the Center for Medicare and Medicaid Innovations to help other practices adopt a collaborative approach.

“Treatment was so accessible, it would be hard for me to find an excuse to skip appointments,” said Glenda Padilla, a Montefiore patient who suffered severe depression and posttraumatic stress disorder after her grandmother died the same week Glenda lived through a major hurricane.

Ms. Padilla, who was enrolled in the collaborative care model, attributes her recovery to having the support of a full team.

“When my son was in the hospital, they made sure to rearrange my appointments. My social worker gave me the tools to cope with my situation and walked me through major life decisions, like my move to upstate New York to better care for my son who has cerebral palsy. My care manager makes sure I stay on-track while at home. I am now in a peaceful place, my children are happy and I am writing a book – all because I was able to get help when life overwhelmed me."

The study took place at Montefiore’s primary care sites and is novel in its comparison of the two models in a clinical setting. Results showed that 44 percent of patients in the collaborative care model had reduced depressive symptoms, compared to only 31 percent of patients in the co-location model. While both models were beneficial, the outcome data collected show that the collaborative care model is more effective in reducing depressive symptoms and helping people cope with challenges they face in their daily lives.

"The results of this study show that when we build systematic and structured teamwork into primary care, we remove barriers for patients who are suffering with behavioral health needs along with their chronic medical illnesses,” said Henry Chung, M.D., senior medical director, Behavioral Health Strategy, Montefiore Health System’s Care Management Organization, professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine, and senior author on the study. "When the team shares information and monitors response to treatment, everyone gets a full picture of what is going on with a particular patient and we can then begin to improve their lives.”

The collaborative care model, which is in place at six Montefiore primary care sites, emphasizes early follow-up with patients, regular evaluation of symptoms, and patient education and self-management support from care managers and social workers. Nearly two-thirds of people suffering from depression and related conditions such as anxiety don’t seek help. The hope is that more collaborative care models can help improve access to evidence-based treatment. 

The project described was supported by Grant Number 1C1CMS331333 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The findings and outcomes presented in this publication may or may not be consistent with or confirmed by the findings of the project’s independent evaluation contractor.