Behavioral health experts met at the 2024 Utah State of Reform Health Policy Conference in March to discuss the integrated behavioral healthcare model.
Adam Cohen, president and CEO of Odyssey House, said the model typically places behavioral health providers into the primary care setting, but it can also include incorporating primary care into a traditional behavioral health setting.
Brent Kelsey, director of the Office of Substance Use and Mental Health at the Utah Department of Health and Human Services (DHHS), said part of the promise of behavioral health integration is to expand access to care for people living with unaddressed substance use disorders (SUDs) and mental health conditions.
“The goal of integration, in my mind, is to provide better care—whole-person care—that addresses a client’s biological, psychological, and social needs,” Kelsey said.
Integrated behavioral health may help providers save money and mitigate workforce shortages, Kelsey added. It can also improve diagnosis times and care coordination, and reduce stigmas surrounding behavioral health conditions.
Rob Wesemann, executive director at the National Alliance on Mental Illness (NAMI) Utah, said integrated care is helpful because people experiencing behavioral health problems often do not know how to seek help.
“If I’m a person with a serious mental health condition, it’s pretty tough day-to-day,” Wesemann said. “And then you expect me to navigate a system that most of us [in the industry] don’t know how to do?”
NAMI has a “warmline” for people to call, and calls often come from family members asking where to get proper services for someone they know to be suffering, Wesemann said.
Lori Wright, CEO of Family Healthcare, said around 70 percent of people with mental health conditions access care with a primary care provider (PCP).
“We’ve been asking PCPs for generations to take care of those patients, whether that’s prescribing [medications] or just [providing] basic care.”
— Wright
Integrating behavioral health into PCP settings allows people to get a higher level of care they would never get traditionally, Wright said.
Family Healthcare’s community health centers use the integrated care model. They serve over 16,000 patients. Last year, they had 64,000 visits, and 16,000 of those were for behavioral health concerns.
“Our behaviorists served 5,400 of our 16,000 patients,” Wright said. “All of those patients were initiated with our integrative program. Many of them go on and get traditional therapy with our behaviorists, [or] we send them to other therapists in the community that match their diagnosis. But we continue to do that primary care.”
Integrated behavioral healthcare can improve physical health outcomes as well as mental health outcomes. For example, Family Healthcare received a five-year grant from the Substance Abuse and Mental Health Services Administration, Wright said. The grant aimed to help people with the dual diagnosis of depression and diabetes. Patients who had a behavioral health provider, along with a PCP, had better physical health outcomes (decreased A1C levels) than patients with the same diagnoses who did not have a behavioral health provider.
The integrated care model also allows providers to become more cognizant of issues that a patient may not be direct about, or issues patients are unaware of.
Cohen discussed a minor who entered his integrated primary care clinic for a physical healthcare problem. She was with an older man, and clinicians were able to discern that she was being trafficked by him. The clinic was then able to get her physical healthcare, SUD treatment, mental health treatment, and helped reunite her with her family.
“That happens all the time. Somebody comes in with a presenting problem, and we can identify something else they may need help with. That’s the promise of integrated care. If you’re blind to one side, or blind to a variety of things, you’re not going to address the underlying issue that might be life or death for that person.”
— Cohen
One obstacle to integrated care is that many people simply do not want treatment, Kelsey said, especially those with SUDs. Often, SUD patients have to be committed or coerced into treatment, he added
“Despite our efforts to integrate our public treatment system, about 85 percent of our referrals for SUD treatment come from the criminal justice system. And less than five percent are coming from physical healthcare providers,” Kelsey said.
Efforts to integrate care also sometimes have unintended consequences, Kelsey said, so healthcare systems need to be clear about what their goals are. PCPs need to ensure they have the resources and skills to provide integrated care, and be aware that there are different levels of integration, including clinical, administrative, and payer integration, he added.
Wesemann discussed policy aiming to improve the state’s behavioral healthcare system. Senate Bill 26, which passed in the legislature in 2024, widens the scope of people who are allowed to practice in behavioral healthcare.
In traditional healthcare, community health workers and peer support specialists support both clinicians and patients, Wesemann said. But those healthcare extenders are less present in behavioral healthcare due to licensing restrictions. SB 26 aims to get more behavioral healthcare extenders in the system by expanding the types of certificates and licenses that are valid in behavioral healthcare.
“This is the way we’re going to get the best value out of our clinicians, and I see it everyday—the value of peers. Someone who has kind of been in your shoes and speaks your language, not the clinical language…You have someone you really kind of connect with.”
— Wesemann
Lawmakers also passed SB 27 during the session, which created the Utah Behavioral Health Commission, Kelsey said.
“[SB 27] is really one of the most exciting developments I have seen in my career,” Kelsey said.
DHHS worked with the Kem C. Gardner Policy Institute, the Utah Hospital Association, and the Utah Substance Use and Mental Health Advisory Council on SB 27 over the last three years, Kelsey said. The commission will have 11 members from a variety of stakeholder groups that will be responsible for coordinating initiatives for the state’s behavioral health system.
“The idea of the commission is not just about improving things within the public system, but also looking at what’s happening for all Utahns across the entire marketplace,” Kelsey said.
Wright said integrating care and improving the behavioral healthcare system requires more collaboration between different types of providers. She emphasized the importance of advocating for change.
“I really believe that if we’re going to address the needs of mental health in Utah, we can’t speak [like], ‘This is the way it’s done,’” Wright said.
Wesemann said affordable housing is vital to integrated behavioral healthcare. He said the legislature’s decision not to prioritize affordable housing in the state’s draft budget for fiscal year 2025 was disappointing.
“If that housing component is missing, a lot of this good work just falls apart,” Wesemann said.