Bringing the Tools of Behavioral Health into Primary Care Practice

January 22, 2016|4:57 p.m.| John Skendall

Some health problems are only skin deep. Some go much deeper. That is why the skills and tools that the field of behavioral health brings are so important. And why they can, and some say should, be under the same roof—even in the same room—as primary care practice.

Behavioral health, a person’s mental and emotional well-being, plays a critical role in ensuring people are able, or better able, to turn the advisement of their doctor or information absorbed elsewhere, into healthful actions. Actions that keep them from swirling in a cycle and coming back with recurring problems. And which can help them live a more fulfilled life.

The Health Resources and Services Administration (HRSA) hosted a webinar this week that featured the leaders of a health provider in Tennessee whose mission—and practice—are built around integrating primary care and behavioral health into the care they provide their population. As they put it, they treat both the body and the mind.

Why integrate primary care and behavioral health?

Primary care and behavioral health are usually two different health services provided in two different places by two separate groups of people. And they are different disciplines at the academic level. Many times, then, the mental and emotional component is separate from that specific point of care. People who walk into a primary care health provider often get treated for a physical symptom or ailment, or their overall physical health is assessed. But while “body” has a set of clues for us to read and measure to diagnose, “mind” is inextricably linked. Mind ensures that good advice is taken. Or that it is heard or able to be understood. Mind steers the ship. Therefore, the principles and techniques of behavioral health can and do benefit the primary care result.

Committed to integrating care  

The mission of Cherokee Health Systems, an integrated care practice in Tennessee, is to blend primary care, behavioral health, and prevention services.

To achieve this, they commit to the following:

  1. Access for all who need our quality health services.
  2. Utilization of an integrated comprehensive approach to health delivery. 
  3. Evaluation of community health needs and development of appropriate programs. 
  4. Demonstration of kindness, compassion, and help at all times. 
  5. Promotion, education, and definition of personal health responsibility. 
  6. Pursuit of organizational harmony and excellence. 
  7. Continually increasing expertise and pursuit of state-of-the-art innovative methods and programs. 
  8. Provision of an environment that is conducive to personal and professional accomplishment and growth.

Training is key  

Febe Wallace, MD, director of primary care services, and Parinda Khatri, PhD, chief clinical officer, at Cherokee Health Systems explained that integration brings great value to their practice, specifically having skilled behavioral health professionals as a resource right in the same building to those administering primary care.

The forms of care that come from these different disciplines may not necessarily always happen in one room, in one session, or at one appointment. But they noted there are advantages across the board to having the healers of body and mind working together, physically in the same office, as a resource to one another.

“It really does expedite care,” Wallace said. “The more you can do when you have the patient with you, the more success you are going to have in helping to move that patient toward wellness.”

Khatri supports the interweaving of disciplines like behavioral health into primary care, but emphasized the need for effective training. She says it will only work if behaviorists make a deliberate effort to impart their skills and knowledge to primary care practitioners, and if those primary care practitioners are eager to listen and cultivate team-based care.

A multifaceted approach may be necessary to treat the underserved  

It is in the context of eastern Tennessee and meeting the needs of people in rural areas with less access and exposure to health care opportunities, that this integrated care shows its unique power. If you want to meet the needs of your whole population, then you need to be able to treat the most difficult to treat—and that means behavioral health is going to have to come into play.

“Cherokee goes where the grass is browner. You need to get more assertive, creative, if you want to provide healthcare with the underserved as your commitment,” Khatri said.

More information

Cherokee Health Systems serves the eastern Tennessee region with several service locations that include integrated health practice, behavioral health services and outreach, and school health clinics.

Wallace and Khatri were the presenters of the webinar “Integrating Behavioral Health Training into Primary Care” hosted by HRSA’s Division of Medicine and Dentistry. The presentation was part of an ongoing series related to topics such as the health workforce.

For more information, see resources from the Center for Integrated Health Solutions (, a cooperative effort of HRSA and the Substance Abuse and Mental Health Services Administration (SAMHSA), and see specifically the report titled Standard Framework for Levels of Integrated Healthcare.

John Skendall is the director of web and new media at ASTHO.