Clinics Where Doctors and Therapists Work Together (It’s Possible)
You might think the only way to get mental health care where you live is to go to a mental health clinic or therapist’s office.
However, thanks to new trends in mental health, that’s no longer true—you may be able to get the care you need locally even if there’s no counseling office anywhere nearby.
Mental health care is now hidden in plain sight all around us. In fact, the closest place to get mental health care in your community could be surprisingly convenient.
It might even be in your own neighborhood, in a place you drive past every day and never thought was an option for mental health care: a primary care doctor’s office.
A growing number of primary care and community health clinics are joining the movement to integrate behavioral health and primary medical care.
Integrated care has been growing in popularity since the 1990s but has only very recently hit its stride. The result is that getting mental health care where you live is easier than ever.
In this article, we’ll explain what integrated mental health treatment is, how it works, where to get it, and whether it might be right for you.
What Is Integrated Mental Health Care?
Integrated mental health care is mental health care that is closely coordinated or combined with medical care, usually primary care. At an integrated clinic, medical and mental health professionals work closely together, either as collaborators and consultants or as part of the same team.
There are many ways medical providers can integrate mental health care into their practices, but the goal is always the same: improve overall health and wellness by treating mind and body together, as the interconnected system they are.
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How Do Primary Care Clinics Integrate Mental Health Care?
There are many ways to integrate medical and mental health care and many levels of integration, from consulting and outreach to combining teams. You might see your local primary care clinic integrating mental health and primary care by:
- Strengthening relationships between their clinic and local mental health agencies;
- Consulting and making referrals to trusted mental health professionals they’ve developed relationships with;
- Fostering collaboration between medical and mental health teams by putting them in the same building;
- Doing “warm hand-offs” where doctors walk patients who need mental health care down the hall to a mental health provider who can see them right away;
- Training primary care doctors to provide basic mental health care to their own patients with support from mental health consultants or team members;
- Incorporating telehealth technology so primary care doctors can consult with mental health professionals and involve them in patient care meetings;
- Setting up secure telehealth rooms where patients can receive mental health services from a remote mental health provider via telehealth technology;
- Placing primary care doctors at behavioral health clinics or community mental health centers so patients can also get medical care at those locations;
- Hiring mental health professionals to work at primary care clinics and provide various mental health services to patients at those clinics; or
- Building integrated teams in which doctors, nurses, and mental health providers are part of the same team and work closely together to treat the same patients.
One approach is not better than the other. Which approach any clinic takes depends on the resources and relationships they already have, their treatment philosophy, and other factors. Any level of integration can help improve patient outcomes significantly!
In a fully integrated clinic, your doctor doesn’t consider your mental health to be separate from your physical health. They understand all aspects of your health are fundamentally connected and address them together by developing a holistic treatment plan.
To do this, they meet with mental health providers who are part of your care team. In their meetings, they discuss your case and plan your treatment. In a fully integrated clinic, this is standard practice for all patients, not just patients with mental health conditions. The care team’s goal is to promote mental and physical wellness in ways that are relevant to all of their patients.
While this level of integration offers unique advantages, you don’t have to go to a fully integrated clinic to benefit from integrated care. Research shows that any degree of integration tends to improve patient outcomes. If your primary care team and mental health team collaborate with each other in any way, you’ll still get better mental health (and primary) care than you would if they didn’t collaborate or consult with each other.
Why Are Primary Care Doctors Offering Mental Health Care?
Some primary care doctors choose to integrate their practices because they were already offering mental health care by default and want to expand and enhance the mental health care they offer. In about 20 percent of primary care visits, patients ask their doctors for help with their mental health.
In fact, you may be wondering if you should bring up the topic yourself. And you probably should. If you’re not sure where to begin addressing your mental health, a primary care office (especially one where you trust and have a good relationship with your doctor) can be a great place to start.
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When Should You Talk to a Primary Care Doctor About Your Mental Health?
You might want to talk to your primary care doctor about your mental health if:
- You’re feeling depressed or anxious and hoping your doctor can prescribe anti-depressant or anti-anxiety medication;
- You’re struggling to follow your doctor’s medical advice because of your mental health and need treatment that will work for you; or
- You suspect mental health issues are the reason you’re experiencing certain medical issues (or vice versa) and don’t want to be misdiagnosed.
In some cases, you can get all of your mental health needs met by your primary care doctor even if they don’t work in an integrated practice. You can learn more by reading our article, “Can I Skip the Psychiatrist and Just See My Doctor?”
All doctors do mental health rotations in medical school, and some primary care physicians are comfortable helping their patients with mental health concerns.
However, many primary care doctors don’t feel fully prepared to address all of their patients’ mental health needs. So, some seek additional training or consult with mental health specialists, especially when a patient’s mental health needs are complex.
To many doctors, it’s a relief to be able to work alongside mental health professionals.
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How Can Doctors and Psychiatrists Work Together?
Some doctors who have integrated clinics hire psychiatrists to be part of their team and work out of offices in the same building.
Others simply build relationships with psychiatrists who have independent practices and consult with them.
Either way, patients benefit—primary care doctors who prescribe mental health medication for patients tend to be more capable and confident in adjusting that medication when they can consult with a psychiatrist, even remotely via telehealth.
Even doctors who haven’t integrated their practices are benefiting from the integrated care movement. It’s easier for them to get information about mental health and get updated training that can help them address their patients’ mental health questions or needs.
So, if you’re not sure whether you need or want to see a therapist, psychiatrist, or other mental health professional just yet, you can start your journey to better mental health by talking to your primary care doctor. They will be expecting to hear about your mental health, and if they can’t fully address your needs, they should be able to refer you to another professional who can.
Can I Get Therapy at an Integrated Clinic?
You’re much more likely to be able to get medication at a primary care clinic than therapy. Medication-based mental health treatment is a natural fit for primary care doctors and is something they can provide even if they don’t have mental health teams on site.
However, a growing number of integrated care clinics are offering therapy to their patients. Doctors know patients who get mental health care tend to have better overall health outcomes, and therapy is a better fit for some people than medication. In response, many primary care clinics are hiring social workers, professional counselors, and other kinds of therapists to work in their buildings.
This level of integration normalizes mental health care and makes getting it a friendlier experience. A “warm handoff”—when a doctor physically takes you to a mental health worker and introduces you to them—can make a huge difference in how you feel about going to that appointment, especially if you haven’t gotten mental health care before.
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What Kind of Therapy Do You Get at an Integrated Clinic?
At an integrated clinic, the kind of therapy you’re most likely to get is short-term therapy that’s focused on solving specific issues connected to your health and wellness.
That’s because therapists on integrated primary care teams tend to specialize in short-term therapy. They often use therapy methods that are focused on problem-solving and symptom management like solution-focused therapy and cognitive behavioral therapy.
They may see you for 30-minute sessions instead of 50-minute sessions. They are often (but not always) limited in the number of sessions they can provide and may refer you to another practitioner if you want or need longer-term care.
Therapists at primary care clinics usually will only see you for a few sessions at a time to address a particular issue. But that doesn’t mean they won’t develop a long-term relationship with you.
It’s important for your care team at an integrated primary care clinic to make sure your mental health needs are being met. Even when they don’t provide long-term therapy, the mental health professional on your team will usually check in with you regularly as long as you’re a patient at that clinic. If a new issue comes up, your team is likely to suggest you get a new round of therapy to address it.
Who Is Integrated Mental Health Care For?
Integrated mental health care is for everyone, but it’s especially effective if you have mild to moderate mental health needs.
Many people already get medication for anxiety or depression from their primary care physician, and for many, this is the only mental health care they get.
For people who only want this kind of care, integrated primary care is a natural fit. Many other people who have mild to moderate mental health needs can get the right level of care at an integrated clinic, too.
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When Is Integrated Care a Good Choice?
In general, you are most likely to benefit from the medication-based treatment and problem-solving therapy offered at an integrated primary care practice if you:
- Have mild to moderate anxiety or depression and want to work with a doctor who can effectively adjust your mental health medications;
- Have physical conditions that affect your mental health (or vice versa) and need to go somewhere that can appropriately address all of your needs;
- Want to do a limited number of therapy sessions that are focused on solving a specific problem in your life; or
- Just need a little clarification, guidance, or support to help you otherwise manage your mental health on your own.
If your mental health needs are more severe or complex, you’ll probably want to work with a mental health specialist instead of or in addition to the mental health professionals who are part of an integrated primary care team.
Most people who seek therapy only end up seeing a therapist for a few sessions before they stop going. Visits to their primary care doctor may be the only interaction they continue to have with any kind of health professional after that.
Integrated primary care was designed with this in mind. By helping people get mental health care who weren’t getting it otherwise, and by encouraging people to continue to address their mental health after an initial episode of care, integrated primary care clinics can fill significant mental health care gaps in their communities.
What Are the Limitations of Integrated Mental Health Care?
Integrated mental health care is designed to complement primary care and is therefore not a replacement for specialty mental health care.
In general, integrated care in a primary care clinic is less intensive than specialty mental health care. When therapy is available at an integrated primary care clinic, it is often only short-term.
So, if you have more intensive needs or want to get long-term therapy for any reason—whether to treat a complex mental health condition or to help you with personal growth—you may not be able to get all your needs met at an integrated primary care clinic.
However, some specialty integrated clinics are an exception and can address the needs of people with complex mental health conditions and people looking for longer-term mental health treatment.
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What's a Behavioral Health Home?
A special kind of integrated care practice called a behavioral health home can help patients with severe mental illness get the care they need.
Their purpose is sort of the reverse of integrated primary care clinics. They are mental health clinics that hire primary care doctors instead of the other way around. They provide specialty and intensive mental health care alongside medical care to help people manage chronic and complex medical and mental health conditions at the same place.
Fortunately, even if they can’t help you at your home clinic, your integrated care team can help you get the specialty care you need, too.
Integrated care teams know how to recognize and refer you to the appropriate level of care when that isn’t something they can provide. In fact, integrated clinics are more likely than other doctor’s offices to keep their referral networks up-to-date and to be able to help you find a therapist outside of their clinic.
They hire behavioral health care managers to do exactly this—follow up with patients until they get their mental health needs met, whether at the clinic or elsewhere.
Where Can I Find an Integrated Clinic Near Me?
It’s not always easy to tell which primary care providers offer integrated behavioral health care, but some openly advertise it.
Some major health systems, like Montefiore in New York, Cherokee Health Systems in Tennessee, and Intermountain in Utah, widely promote the fact they offer integrated mental health at their primary care locations. If you’re familiar with such a provider in your area, you can go to their website to find a location near you.
However, many integrated programs don’t invest in such wide-scale advertising efforts. Instead, they simply indicate on their individual webpages that they offer integrated care. If you find a local primary care provider through an internet search for integrated care, but can’t confirm on their page that they actually offer it, we recommend that you call them to ask.
If you’re not sure where to start, there are also search engines and directories like The Integrated Care Map that can help you find the closest integrated clinic.
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The Integrated Care Map
Many integrated care practices are members of the Collaborative Family Healthcare Association (CFHA) and add themselves to CFHA’s searchable Integrated Care Map.
This is one of the only national integrated primary care practice directories we found in our research. Its listings are somewhat limited but do include providers across the United States.
Another way to find an integrated care practice is to search for a community health center (CHC) using the official online search tool on the U.S. Health Resources and Services Administration website.
This database lists every federally qualified health center (FQHC) in the United States. Most FQHCs offer some level of integrated care, but this can vary from center to center, so it’s worth calling your local FQHC to check.
What Is a Community Health Center?
“Community health center” and “federally qualified health center” are interchangeable terms for a special kind of federally-funded integrated health clinic.
The purpose of a CHC or FQHC is to provide coordinated care to people who live in areas where good primary healthcare was once hard to find.
They focus not only on providing primary care, but also on offering an array of services that make it easier to access primary care, including transportation and translation services. Many of them also provide behavioral health services.
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History Corner: Community Health Centers and the "War on Poverty"
Community health centers have been around since 1965. They were founded as part of the “War on Poverty” and their goal is to make high-quality healthcare available to people who otherwise couldn’t afford it or find it close to where they live.
Community health centers got a boost—and an update—more recently from the Affordable Care Act (ACA) in 2010. As part of that update, many started integrating behavioral health services and departments into their clinics.
The ACA increased funding for FQHCs and encouraged them to include mental health services as one of the essential services at their clinics.
The widescale adoption of integrated mental health by FQHCs since then has made affordable mental health care available in many locations where it was once hard to get, including dense urban centers and rural areas in sparsely populated states. In our research on the public mental health system, we’ve found that CHCs and FQHCs are often the only places offering mental health services for miles around.
They’re also one of the most accessible options. They don’t have the same kind of strict eligibility requirements as many community mental health centers (CMHCs), the main type of outpatient mental health provider in the public mental health system. However, they offer similarly discounted care.
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Health Centers Are for Everyone
While community health centers were founded to help people living in poverty access high-quality medical care, their services are usually available to anyone who lives near them and are usually not restricted to people with certain income levels.
Each CHC or FQHC accepts Medicaid and Medicare (as well as a range of private insurance plans) and offers sliding-scale fees to people without insurance.
It’s important to note that FQHCs and CHCs are not rudimentary “free clinics.” Often, they are among the most advanced health clinics in their area, using cutting-edge technology and new, evidence-based healthcare practices to deliver high-quality care in updated facilities. They are often parts of large clinic networks that span entire states or regions and receive significant local as well as federal funding. We think more people should know about and use them.
Conclusion
Integrated care makes it possible to get mental health care in places it wasn’t available before, including primary care clinics, large regional hospital systems, and other traditional healthcare providers.
It’s an idea whose time has come. With each passing year, more clinics are offering integrated care. The result is that more people are getting the mental health care they need.
Integrated primary care clinics focus on the relationship between mental and physical health and address both in a seamless way.
This enlightened approach to care can improve physical, mental, and overall health outcomes for all patients. It also improves access to mental health care by reducing stigma and removing financial and geographic barriers to care.
Integrated care is designed with everyone in mind. It can help treat as well as prevent many mental health conditions and is a great option if you need to address both mental and physical health issues.
However, it has limitations, and can’t always address severe or complex mental health conditions. It also usually isn’t a place to get long-term therapy for personal growth or self-exploration. Integrated clinics typically offer short-term, problem-focused therapy.
However, people who work at integrated clinics are knowledgeable about local mental health resources, and if they don’t offer the care you need, they will refer you to a provider who can.
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Is an Integrated Clinic Right for You?
It’s possible to get all of your mental health needs met at an integrated clinic, especially if you’re seeking medication-based treatment.
It’s also possible to get therapy at an increasing number of integrated clinics, though it’s often short-term. If you’re wanting intensive or specialty mental health services, you may need or want more than an integrated primary care clinic can offer.
Even if you end up going somewhere else to get the care you need, talking to your primary care doctor can be a great way to get started on your mental health journey.
Your doctor expects to hear about your mental health and wants to help you with it. Let them know if it’s something you want to address. They might provide your mental healthcare themselves, take you to a mental health professional in the same building, or give you a good referral to a local therapist.
So, if you’re thinking about getting mental health care, but you’re not sure where to start, consider talking to your doctor the next time you see them. You might be surprised by how much they can help.