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Mental Health Integration (MHI)

Mental Health Integration or MHI is collaborative mental health care that is integrated into everyday primary care practice. There are many evidence-based approaches to MHI, but typically there is a licensed mental health professional working as part of the primary care clinic to help clarify the patient's diagnosis, determine complexity, and plan treatment.

In a team-based MHI model, primary care providers (PCPs) and office staff collaborate with care managers and mental health specialists to implement individualized strategies, which:

  • Improve clinical decisions
  • Help patients and families receive services within the primary care setting
  • Reduce primary care physician burden

There are many ways to integrate mental health care. The most-common strategies include coordinated care, co-located care, and integrated care:

Coordinated care

This approach involves minimal collaboration or basic collaboration at a distance. In this model, primary care and behavioral health providers communicate about shared patients but maintain separate facilities and systems.

Co-located care

This approach reflects basic collaboration onsite or close collaboration, with some system integration. Behavioral health and primary care providers in a co-located practice may share the same facility, but not necessarily the same practice space.

For example, in one rural community, a primary care practice is in the same facility as the county's mental health agency. Primary care providers walk their patients over to the agency and introduce them to a clinical social worker.

Integrated care

This approach focuses on collaborative care that adds two, key services to the primary care setting:

  • Care management support for patients receiving behavioral health treatment
  • Behavioral health provider inter-specialty consultation with the primary care team

In this model, providers jointly plan and execute goals, develop integrated care plans, co-manage patients, and maintain shared schedules. Integrated practices use a systematic clinical approach to identify patients who need behavioral health services and engage providers and patients in shared decision making.

How is depression screening key to MHI?

Care that combines depression screening with adequate support systems, such as talk therapy and medication management, improves clinical outcomes for patients. These evidence-based patient health questionnaires can be administered by a variety of staff using different approaches.

  • PHQ-2: A brief screening tool that can be used during a routine intake or annual physical examination
  • PHQ-9: A tool administered to patients with a positive PHQ-2 screening result to confirm the diagnosis and assess severity
  • Example Depression Screening Workflow: See how the PHQ tools interact together in this simple workflow. 

Follow-up guidelines for PCPs

  • Ensure patients have a follow-up appointment within 7 days of discharge from an ED or inpatient facility when the visit/admission was for substance abuse or mental illness (or within 30 days if 7 is not possible).
  • Patients who screen positive for depression on a standardized screening tool should have a follow up visit within 30 days.