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Integrated behavioral health

Many medical conditions are greatly affected by patients' mental health and behavioral choices. Physician-led primary care teams often must address many common mental health disorders, such as depression, anxiety and substance abuse. By bringing medical and behavioral health services together within primary care, the team is better able to meet both the mental and physical health needs of the patient.

That’s why the AMA continues to provide physician practices with tools and practical solutions to integrate these two crucial areas of care into one. 

BHI Collaborative

The AMA and seven leading medical associations have established the BHI Collaborative, a group dedicated to catalyzing effective and sustainable integration of behavioral and mental health care into physician practices.

Learn about the BHI Collaborative

Dedicated to catalyzing effective, sustainable integration of behavioral health care into physician practices.

With a focus on primary care, the Collaborative is committed to ensuring a professionally satisfying, sustainable physician practice experience and will act as a trusted partner to help them overcome the obstacles that stand in the way of meeting their patients’ mental and behavioral health needs.

Overcoming Obstacles webinar series

Presented by the BHI Collaborative, this series will enable physicians to sustain a collaborative, integrated, whole-person, and equitable approach to physical and behavioral health care in their practices during the COVID-19 pandemic and beyond.

RAND/AMA BHI Study

RAND/AMA Behavioral Health Integration (BHI) study

The integration of behavioral and physical health care has long been identified as one of the more effective solutions to increasing access to treatment for many mental health conditions. However, in spite of such strong recognition, sustained BHI has occurred in only a small subset of practices to date.

RAND/AMA BHI study

AMA and the RAND Corporation recently conducted a study on behavioral health integration and physician practices.

AMA set out in 2019 to better understand the specific factors influencing BHI into practices to inform the AMA’s support for development of potential solutions that address persistent disparities in access to and quality of care.

AMA partnered with the RAND Corporation to learn about the motivators, facilitators and barriers to BHI from physician practices with firsthand experience. Information was collected about (1) their decision making processes for choosing a BHI model and implementing it; (2) barriers encountered in implementing BHI; (3) strategies used to overcome such barriers; (4) financial and non-financial resources that were (or would have been) helpful for implementation; and (5) lessons or advice for other practices considering whether and how to implement BHI.

Key findings of RAND/AMA study

1. Physician practices had broad motivations for BHI including expanding access behavioral health services, improving other clinicians' abilities to respond to patients' behavioral health needs and enhancing practice reputation.

2. Physician practices tailored implementation of models to fit their individual contexts including local resources, financial incentives and patient populations.

3. Physician practices faced multiple barriers to successful integration including cultural differences, incomplete information flow between behavioral and non-behavioral health clinicians and billing difficulties.

4. Physician practices utilized a variety of approaches to financially support integration, not all of which are sustainable.

These findings should help identify and spread effective solutions for sustainable BHI, particularly as physicians and their practices continue to face new and unfamiliar challenges in delivering care to patients in response to COVID-19.

Practices are concerned about safely delivering necessary care to patients and about postponing non-essential care. New for many practices is having to consider current and future needs for clinician services, including behavioral health care, as the amount of stress-related disorders and other mental illnesses generated from the pandemic’s impact on the global community have risen sharply.

Considerations for integrating behavioral health into a practice’s business model are being more widely examined in parallel with physicians’ need to address their own mental health and well-being.

COVID-19 impact

COVID-19 pandemic: Impact on behavioral & mental health

Not a day goes by during which the profession and the public aren’t reminded of the immense impact the COVID-19 pandemic has had on the behavioral and mental health and well-being of patients, physicians, other clinicians and the public.

Featured updates: COVID-19

Track the evolving situation with the AMA's library of the most up-to-date resources from JAMA, CDC and WHO.

Exposure to the virus, grueling hours, lack of personal protective equipment (PPE), other challenges to providing effective care and concern about the health of their coworkers and of their own families adds to the stress experienced by physicians who may have already been overwhelmed or burned out prior to the pandemic.

If there is a silver lining to be found, it may be that this greater awareness and more open discussion may reduce some of the long-standing stigma that has at times stood in the way of individuals seeking the help they need.

AMA resources on behavioral health

In response to the pandemic, the AMA is providing evidenced-based tools, resources and information on behavioral health. These include:

—The AMA/RAND behavioral health study published as original research in the Annals of Internal Medicine. Please refer to the first tab for key findings.

—The new mental health resources page highlighting specific recommendations on how physicians can take care of themselves, their staff and their patients.

Implementation guidance to support increased use of telehealth services and advocacy for continued policy flexibilities across payers (waived cost-sharing, payment parity, etc.).

Headspace—an AMA-preferred provider of meditation and mindfulness—is offering U.S.-based health care professionals with a National Provider Identifier a free subscription to Headspace Plus through 2020. AMA members can sign up for a 2-year subscription for free.

—A Caring for our caregivers during COVID-19 guide for health system leadership to consider using to support their physicians and care teams during COVID-19. The guide provides practical examples and strategies to encourage well-being and improve physician satisfaction. The guide includes valuable strategies that address workload redistribution, institutional policies, meals, childcare, attention to emotional and mental well-being and connecting with others.

Adoption of BHI in practice

Additionally, AMA is also seeking and creating opportunities to accelerate the adoption of behavioral health integration (BHI) in practice and increase its long-term sustainability. In the lead up to this effort, AMA has found that:

—Identification and management of behavioral health conditions should be a core competency of primary care practice, not an exception.

—Physician practices need help addressing and overcoming the stigma (internal and external) that has for too long been associated with behavioral health conditions.

—For BHI to be financially sustainable, practices need specific billing, coding and contracting guidance, as well as access to actionable data, to help demonstrate the benefits such efforts can have on patient satisfaction, clinical outcomes and the total cost of care.

—Many resources currently exist to help practices implement BHI. However, these tend to focus on specific models, which do not necessarily fit the circumstances of a particular practice (i.e., how it is structured, resources available locally and specific patient population needs).

—Smaller practices, including those in less populous environments, need more help identifying and implementing best practices specific to their needs.

—Workforce shortages are an issue, particularly in rural areas, where there are not enough clinicians to meet the demand for behavioral health services.

Educational resources

Additional resources

AMA STEPS Forward™

At STEPS Forward, nearly 60 modules represent expert-driven, field-tested strategies designed to help you successfully implement meaningful and transformative change in your practice. Each module includes a step-by-step guide and downloadable tools and resources to assist in implementation.

Perspectives with the AMA podcast series

Featuring insights from health care leaders, this perspectives from the AMA series is a must for any health care professional who wants to stay up to date on the latest issues and trending topics in the space, including value-based care, telehealth, the opioid epidemic, Medicare payment, cyber security and much more.

Behavioral Health Integration: Exploring Its Effect on Clinical Practice: Hear from physician experts on how they helped lead the implementation of a more integrative approach to behavioral health services within their organizations.  

Managing mental health during COVID-19

The American Medical Association (AMA) has collected resources to help physicians cope with increased levels of distress and anxiety during the COVID-19 pandemic. The curated resources build on the AMA’s ongoing efforts to ensure physicians and other frontline health care professionals have access to the latest news and information in a rapidly changing environment, including tools to manage their own mental health and well-being as they continue caring for patients.

Additional resources from other specialty associations are relevant to all of medicine. These evidence-based resources are brief and focus on actionable steps for physicians.

Coronavirus and mental health: Taking care of ourselves during infectious disease outbreaks (APA)

Notifying families after a COVID-19 death (CSTS) (PDF)

Supporting families of healthcare workers exposed to COVID-19 (CSTS) (PDF)

Getting better sleep during COVID-19: A guide for hospital workers (CSTS) (PDF)

Tips for coping when quarantined with COVID-19 family members (CSTS) (PDF)

Physician Innovation Network (PIN) virtual discussion

How has COVID-19 affected behavioral health and mental health needs within your practice?  In a time when physical distancing and isolation are necessary responses to COVID-19, health care clinicians are rightfully concerned about their personal mental health as well as that of their colleagues, family members and patients.

View the latest discussion and engage with expert panelists, learn and share best practices and discuss how COVID-19 has affected behavioral health within your practice for you and your patients.

Opioid resources

End the Opioid Epidemic

AMA policies