Mobilizing primary care providers to address the mental health care shortage

Half of all Americans experience mental health problems during their lifetimes, and nearly two-thirds of those are not able to get care for it. A chronic shortage of psychiatric providers leaves patients lingering on waitlists for months without help, and poor insurance coverage can make it difficult for patients to find care at all. “Payers and policymakers must act urgently to ensure primary care physicians and their care teams have the support they need to provide coordinated, equitable care for their patients and families,” wrote Jack Resneck, Jr., then president of the AMA, in 2022, urging an increase in behavioral health integration to address the scarcity of care.  

A decade ago, Neda Laiteerapong, associate professor of medicine and associate director of the Center for Chronic Disease Research and Policy, banded together with Lisa Vinci, Mim Ari, Fabiana Araujo, Daniel Yohanna, Nancy Beckman, and Erin Staab, colleagues in the UCM Primary Care Group and Department of Psychiatry at the University of Chicago who were determined to get their patients the mental health care they needed.

“We started meeting and complaining and wishing for a different world—a world where patients with mental health problems could actually get mental health care quickly and appropriately,” Laiteerapong says. With some pilot funding from the University, the group began developing a method for depression screening through primary care. At ten years old, the UChicago Primary Care - Behavioral Health Integration Program (BHIP) has become an innovation ground for improving clinical care and addressing mental health needs on the south side of Chicago, earning recognition by the Association of American Medical Colleges (AAMC) with a 2024 Integrated Behavioral Health Award.

Putting tools in the hands of primary care providers

To offset provider shortage and lengthy waitlists, the BHIP puts the knowledge and skills of mental health specialists into the hands of primary care clinicians and nurses. One simple way they help kickstart treatment is through their library of one-page clinical decision support tools. Available online, through the electronic health record, and sent weekly over email, these resources offer screening, diagnosis, and management guidance for those in primary care treating patients with common mental health problems—such as depression, anxiety, ADHD, eating disorders, PTSD, and suicidality—including questions to ask patients, medications to prescribe and how to adjust the dosage, effective therapies to treat the problem, patient education resources available, and more.

“We usually don't recommend referring most conditions to psychiatry right away,” notes Laiteerapong. “We say, ‘Ok, here’s the first step, here’s the second step, here’s the third step—if all those fail, then go to psychiatry.’”

For patients, a growing library of educational materials developed in collaboration with a health literacy team at the University of Chicago offers easy-to-read guidance on mental health conditions, treatments such as cognitive behavioral therapy (CBT), mindfulness, helpful cell phone apps, and other resources, including legal aid.

“These are meant to move people from what we call ‘precontemplation’—they’re not even thinking about going to therapy—to ‘contemplation’—maybe I'll go to therapy—to action,” says Laiteerapong. “Sometimes people aren't ready for therapy yet, but they need some sort of help and time to process and think about things. We have all those handouts in the hallways, and people will grab them. Everyone's always grabbing them ‘for a friend.’”

Currently, the BHIP is expanding depression screening, which it has done in primary care clinics since 2016, across specialty clinics for both pediatric and adult patients in the UChicago health system. “We think that will help a lot of people who have problems with depression who don't always come to primary care here,” says Laiteerapong.

Building partnerships

Since 2018, BHIP has also built alliances with community partners who can give care to patients who need more help than what primary care can offer. From its beginnings in the Hyde Park neighborhood, the program now includes partners in other areas of Chicago, as well as Indiana, where patients can receive care by telehealth. Fabiana Araujo, assistant professor of psychiatry at UChicago and co-director of BHIP, has been leading the effort to match patients with community partners that take their insurance and offer the kind of help they need.

“We’ve always sought out partners who are interested in taking care of people who have less access to mental health care,” says Laiteerapong. And the benefits are mutual: “From our partners what we hear is that it's good for them because they don't have to worry as much about advertising costs for their group, and they also can get matched with clients that are more appropriate for their therapy group. They can decrease the search costs that they have to spend, as well as time triaging, and spend more time on direct patient care.”  

Often when addressing gaps in mental health care, integrated behavioral health programs focus on a collaborative care model, in which behavioral health care managers, psychiatrists, social workers, and other mental health professionals are added to a team led by a primary care physician to manage a patient’s mental health problems.

“While we do have a collaborative care model and behavioral health clinic [at UCM], it is not enough,” says Laiteerapong. Instead, the BHIP strives to empower primary care physicians and nurses to deliver mental health care themselves. “Our program for behavioral health integration is novel in that we emphasize clinical support tools and informatics integration,” she said.

Expanding and refining the mission

BHIP is currently conducting an evaluation to measure the effectiveness of this increasing scope of practice for primary care doctors. Early results suggest that the BHIP has changed clinical practice for UChicago’s primary care doctors: they are taking on more mental health problems. If their methods prove successful, BHIP plans to expand the program to the south side of Chicago, federally qualified health centers, and other places where people need help.

The national recognition by the AAMC offers even more opportunities for BHIP to expand and refine its mission. “It puts us at the table with others across the country doing this work to share best practices and to come up with guidance for other academic medical centers that are thinking about integrating behavioral health,” says Laiteerapong.

“We're trying to change the culture by increasing mental health literacy—the mental health care literacy of primary care clinicians, as well as the community they serve,” she continued. “30% of people who die by suicide saw a healthcare provider in the last seven days of their lives. People want help, and they're not able to get the help they need or necessarily talk about it. Getting our clinicians to be more comfortable having that door open, to realize that mental health is physical health—that if someone’s depressed, they may not take their medicines, they’re going to have more physical complaints, they're not going to follow up on the test that you recommended, they have higher rates of hospitalization and ER visits—that’s everyone’s problem.

“Giving everyone solutions that can be practically implemented within our clinical workflow could change the paradigm of how we practice medicine.”