• In The Trenches

    We’re Sharpening Our Focus on Behavioral Health Care

    February 15, 2022, 4:21 p.m. — I’m going to tell you something you already know: Each day, now more than ever, you deliver behavioral health care, and you do it without nearly enough acknowledgement or support from payers and regulators.

    Family physicians perform nearly 40% of all visits by patients seeking treatment for depression, anxiety, substance use disorder and other mental health concerns. Your offices are the settings in which almost a third of the care and a quarter of the prescriptions for serious mental illness are administered. You’re at the center of the fight to make such care accessible, affordable and equitable.

    That’s why the Academy is ramping up its push to center primary care in behavioral health policy. This month, for instance, in testimony and letters, we’ve laid out our case to Congress for the strongest possible integration of behavioral health care in primary care settings for children and adults. And we are working to introduce legislation that would achieve these aims.

    Specifically, we’re asking federal and state lawmakers and regulators to improve patient access to behavioral health services, including the diagnosis and treatment of depression, anxiety, post-traumatic stress disorder, substance use disorder and other mental health concerns. We’re also advocating for improved payment for these services, investments in training and education for physicians to integrate behavioral health into their practices and other measures to better facilitate and reimburse

    • care-coordination efforts with other behavioral health clinicians,
    • medication-assisted treatment for substance use disorders,
    • mental and behavioral health services for children and adolescents, and
    • maternal mental health care.

    We all know how crucial this is. As two years of a public health emergency skid into a third, U.S. mental wellbeing is being challenged as never before. Some 139 million Americans live in mental health professional shortage areas. Women of color and women living in medically underserved communities experience higher rates of postpartum depression and are at higher risk of maternal mental health conditions. Black and Hispanic individuals are less likely than white individuals to receive care for mental illness.

    This mental health crisis includes children and adolescents, one in five of whom experiences a mental health condition each year. That’s why the Academy last fall supported the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association in declaring children’s mental health a national emergency.

    In fact, more than 14 million American children and adolescents have a diagnosable mental health disorder, and CDC data indicate that suicide is the second-leading cause of death for people ages 10 to 24. These are shocking numbers — unless you’re a primary care physician. In which case you already know something else: These trends simply won’t improve without meaningful policy changes such as those we’re outlining.

    With this in mind, in Feb. 8 testimony for a Senate Finance Committee hearing titled “Protecting Youth Mental Health: Part I — An Advisory and Call to Action,” we urged action to bolster whole-person primary care that includes behavioral health services. We called on Congress to

    • pass the Ensuring Access to Primary Care for Women and Children Act, which would return Medicaid payments for primary care services to Medicare payment levels for two years and expand the number of clinicians eligible for this increase;
    • pass legislation to establish a Medicaid demonstration program providing infrastructure, technical assistance and sustainable financing for expanding access to integrated mental health care for children in primary care, schools or other critical settings, including through telehealth;
    • direct CMS to review Early and Periodic Screening, Diagnostic and Treatment implementation in states and clarify coverage of EPSDT services;
    • pass legislation directing HHS to create and implement a plan to improve measurement of the extent to which children and adults have access to integrated mental health care in primary care and the effectiveness of the care provided; and
    • make investments to improve care coordination between schools and primary care physicians.

    We were active on this front last year, too, following the late-2020 formation by the AAFP and seven other physician organizations of the Behavioral Health Integration Collaborative. The Academy and 17 other medical and health care groups last fall also endorsed legislation that would help advance the collaborative care model in primary care offices. Research strongly supports the effectiveness of this approach, in which a primary care physician leads a multidisciplinary team (including a psychiatric consultant and a care manager) to treat a patient’s behavioral health issues. As a recent FPM editorial put it, “Fully integrating behavioral health in primary care is the gold standard for care. … It is not meant to be a handoff of care, but a team-based approach supporting the work of the primary care physician.” It’s covered by Medicare and many states’ Medicaid programs, yet barriers such as startup costs and financial sustainability for small practices are hampering its uptake.

    Because addressing Americans’ mental health needs in the aftermath of the pandemic deepens and complicates the challenges you’ve undertaken for two years, securing improved integration and payment for behavioral health care in primary care practices is now among the Academy’s top priorities. You’re likely the first point of contact for many patients who need mental health care. Too often, you may be the only available source of such care for those in medically underserved communities. That pressure on family physicians is unsustainable, and it’s time to make some big corrections. The Academy means to lead the way forward.


    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.