How Cognitive Care Fits Into Integrated Behavioral Healthcare

About half of those who experience a mental illness during their lives will also experience a substance use disorder and vice versa, according to multiple national population surveys (NIDA, 2020; NIDA, 2022). 

Fortunately, studies show that improving mental health can also have positive impacts on behavioral health and quality of life more broadly. Nine out of 16 studies which assessed the MCS or mental health subscale using SF-36 or SF-12, showed that better mental health was associated with lower mortality risk (Phyo et al 2020).

Behavioral healthcare services are related to whole person health as well as mental health services, in that this field of health focuses on the way thought patterns, learned emotional responses, and coping mechanisms can affect how people react to daily life (Healthline, 2024).

But along with treating physical and psychological symptoms associated with these disorders, behavioral health services also address patients’ emotional wellbeing and social wellness factors. Healthcare teams that address behavioral health often involve a collaboration between primary care teams, general practitioners, and behavioral health specialists.

In this article, we explore how cognitive and mental health fits into the larger picture of behavioral healthcare, and how it can lead to more positive health outcomes for patients.

What is Behavioral Healthcare?

Behavioral healthcare (American Psychiatric Association, 2024) is a healthcare specialization that focuses on mental health, maladaptive behaviors that impact a person’s everyday life, and substance use disorders. 

Behavioral healthcare can include specialized treatment methods, such as:

• Cognitive behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Substance abuse counseling
• Acceptance and commitment therapy (ACT)
• Mindfulness-based cognitive therapy (MBCT)
• Motivational interviewing
• Social services
• Medication management

The co-occurrence of substance abuse disorders with mental health disorders is very common. One review identified up to 66% of patients dealing with substance abuse reported also having a mental illness diagnosis, of which depression was the most prevalent (57%). (Davis et. al 2022) Behavioral healthcare services aim to address these comorbid conditions, and build treatment plans that address individual patients’ needs.

Examples of Behavioral Health

Where mental health refers to a person’s psychological state, behavioral health refers to the behaviors that may arise as a result of that state. Behavioral healthcare identifies the ways in which these behaviors impact and relate to a patient’s physical, emotional, and mental wellness.

A person’s behavioral health (AMA, 2022) can refer to their:

• Habits
• Lifestyle
• Social interactions
• Coping strategies
• Risk assessment

One study connects the ways that behavioral interventions promote metabolic health, such as diet improvements, increased physical activity, stress management, and sustainable behavioral changes, which can promote better mental health and reduce the potential for chronic diseases (Oster et al, 2023). 

Behavioral healthcare services are there to help empower patients to make choices associated with better health outcomes. And because mental and behavioral health are so deeply tied, many psychological treatments focus on emotional regulation and overcoming painful thought patterns. 

What is Behavioral Health Integration?

Behavioral health integration is the practice of collaborative treatment between patients’ primary care team and other behavioral health care professionals (APA, 2024). This may relieve additional responsibility off of any one clinician to manage the many facets of patients’ comorbidities, and helps address mental and physical health in tandem.

This method can also greatly improve patient outcomes: It was found that 75% of the time, patients who are treated with collaborative interventions reach a diagnosis and begin treatment within 6 months (Reist et al, 2022). This is in comparison to standard treatment rates, where in some cases only 25% of patients may receive care within the same timeframe.

Here are a few healthcare approaches associated with behavioral health integration:

Whole Person Care

Whole person care considers and addresses multiple aspects of patient well being, and explores the ways in which they are interconnected.

These aspects often include a patient’s:

• Physical health
• Mental health
• Cognitive health
• Lifestyle choices
• Social health and relationships
• Environmental and socioeconomic conditions
• Spiritual worldview

One major element of whole person care is collaboration between providers and patients. For example, clinicians might offer patient-led behavioral health questionnaires to obtain subjective data directly from patients. With this supplemental information, clinicians can form a treatment plan that acknowledges patients’ individual concerns and behavioral health goals.

Patient-Centered Approach

Patient-centered care is a model that strives to empower patients to participate in their treatment plan. Within this approach, health care professionals play an important role in educating and advising patients, as well as providing them the resources they need to achieve their preferred health outcomes.

Similar to whole person care, patient-centered care addresses multiple facets of patient health, and addresses emotional needs, beliefs and values, financial capacity, and personal preferences. Along with this, collaboration with family members is common.

On a systemic level, patient-centered care includes:

• Organized and accessible healthcare services
• Information that is shared in an open and timely manner
• Patient-centered mission, vision, and values for clinics

Mental health barriers may contribute to patients avoiding seeking healthcare (Taber et al, 2015). Understanding patients’ unique mental health challenges and triggers can help facilitate a more positive healthcare experience, and guide them towards an effective treatment plan.

Coordinated & Continuous Care

Organized and coordinated care between specialists is a key part of effective treatment, services, and programs.

Along with this, continuity of care prevents patients from needing to repeat themselves, and helps healthcare professionals:

• Avoid miscommunications between patients and other providers
• Confidently refer to information provided by specialists on the primary care team
• Use their resources effectively to reduce costs (Breckenridge 2019)

Behavioral health integration, where primary care and mental health services work closely together, contributes to continuous care. Care coordination between the primary care team members can be enhanced with a strong toolkit. For example, easy-to-use reporting tools can be integrated into patients’ electronic health records (EHR), maintaining detailed data in one place.

Evidence-Based Practice

Evidence-based practice is an established care model that prioritizes using the best available evidence for clinical decision-making and treatment strategies.

Rather than taking a one-size-fits-all approach, evidence-based practice is guided by:

• Credible, valid, and reliable scientific research
• Clinical expertise
• Patient preferences and values

Integrating evidence-based practice into behavioral healthcare means combining scientific research, objective assessment tools, and patients’ self reports, as well as staying up-to-date with the latest literature on treatments and practices that are most recent, relevant, and effective. Behavioral health specialists such as substance abuse counselors and community workers can also offer key expertise to give these patients the support they need.

Social Care

Social care refers to the practical and social support programs that exist to help with behavioral health conditions. Where a psychiatrist might seek the right medication for a patient, social care providers address the social, emotional, and practical needs of patients. Both can be essential for the appropriate care of a patient.

Some social care resources and programs might include:

• Support services such as housing, transportation, and financial management.
• Community resources such as social groups, group therapy, and addiction support.
• Advocacy for navigating the healthcare or legal system.
• Job training or support for independent living skills.

An 18-month study from the National Academies identified five important factors for integrating social care into healthcare: awareness, adjustment, assistance, alignment, and advocacy (National Academies Press Engineering, and Medicine, 2018). Physicians can tap into the benefits of social care by connecting with behavioral health specialists who offer social services.

Benefits to Incorporating Behavioral Health Services

There are several benefits to incorporating behavioral healthcare services into primary care services, including:

• Improved health outcomes and quality of life related to integrated screening tools and protocols for cognitive and mental health (Phyo et al 2020). In cases of substance use, early intervention is one of the most effective components of successful treatment (Department of Health and Human Services). 
  • Mental and behavioral health screeners such as the AUDIT (alcohol abuse), DAST-10 (drug abuse), PHQ-9 (depression), GAD-7 (anxiety) enable primary care providers to identify patient needs.

• Reducing stigma around mental health conditions by normalizing conversations about mental illness and substance use disorders (Rossler 2016).

• Cost saving in the long term. One American Psychiatric Association study found that fully integrating behavioral health services with physical treatment could save the American healthcare system $26–$48 billion dollars each year (APA, 2020).

• Increase patient compliance with mental health treatment. One study found that 49.3% of patients who received a depression diagnosis from a Primary Care-Mental Health Integration (PC-MHI) screen initiated treatment the same day (Szymanski, 2012).

Studies show that the cost of implementing behavioral health programs is relatively low for most clinics, coming in at around $20,000 over 24 months, according to one study (Translational Behavioral Medicine).

One instance of integrated behavioral health services saved $1.08 million for Medicare, Medicaid, and dual-eligible patients thanks to reduced hospitalizations. Clinics who participated in this program also had higher rates of screening and diagnosing for anxiety and depression-related mental illness.

Putting Behavioral Health Into Practice Alongside Cognitive Care For Older Adults

According to the World Health Organization (WHO), more than 55 million people worldwide have dementia, with an expected 10 million new cases to emerge each year. With this expanding population of patients, brain care is an increasingly essential part of primary care services.

Often, older patients’ behavioral health can provide useful clues about the state of their cognitive health. However, overlapping symptoms—such as the connections between sleep, depression, and cognition (Faucher et al, 2024)—can make signs of cognitive decline difficult to disentangle from symptoms of mental illness.

Behavioral and psychological symptoms of dementia (Cloak et al, 2024) can include:

• Notable personality changes
• Inappropriate social behavior
• Apathy and withdrawal from social activities
• Verbal or physical aggression
• Delusions or hallucinations
• Decreased sleep or appetite
• Increased anxiety
• Depression

Regularly testing cognitive function in tandem with integrated mental health screens can help providers accurately diagnose and treat patients. Along with this, thorough record-keeping can help practitioners make informed decisions and diagnoses based on patient lifestyle factors, comorbid conditions, medical history, and early-life mental disorders. 

These evaluations help determine if a patient is at greater risk of cognitive impairment. For example, one thirty-year study found that people with early-life mental disorders were at a higher risk of developing dementia, and having it onset at a younger age (Richmond-Rakerd et al, 2022).

For older patients with cognitive or mental health conditions, physicians can connect them with behavioral health specialists such as:

• Geriatric psychologists
• Recreation therapists
• Memory care providers
• Support group leaders
• Substance abuse counselors

Keeping older adults active and connected to their communities is ideal for improving aspects of their physical and mental health and promoting healthy lifestyle habits. Examples include: healthy diet habits, proper use of health care resources, avoiding strong emotions, tension, and stress, regular physical activity, avoiding tobacco, alcohol, and drug use (Chia et al, 2023). Sometimes, simply organizing access to reliable transportation can make a large difference in a patient’s quality of life.

Using Technology to Deliver Behavioral Healthcare

One of the biggest barriers to integrating behavioral healthcare in primary care clinics comes down to challenges with teamwork (AMA). Many physicians are already overloaded, and may not feel like they have time for the training required to adapt this new model.

With the right healthcare software, providers can begin integrating behavioral health services into primary care while also reducing their administrative load.

Using the Creyos cognitive and behavioral health platform:

• Can be administered both virtually and in-person.
• Integrates reports into patient EHRs, promoting collaboration between providers.
• Saves time on cognitive assessment so providers can spend more time working on ideal treatment plans for each patient.
• Is easy to use for patients as well as providers, making cognitive screens and mental health assessments less stressful.

The features of this platform include:

• Validated, computerized  tasks that assess specific facets of patients’ cognitive ability including short-term memory, reasoning, attention, and verbal skills.
• Standardized behavioral health questionnaires that can aid in the identification of anxiety, mood disorders, substance misuse, ADHD, and more.
• Scientifically-backed, ready-made protocols to make diagnosis more efficient.
• Instant, data-driven reports that help facilitate cognitive and behavioral health conversations with patients.

Gabrielle Thompson, founder of GT Healthcare, found that Creyos’ platform helped clinicians confidently diagnose patients and implement a treatment plan in 2–3 visits. Along with this, the administrative team reported saving 1–1.5 hours per day on session notes.

Connect with us today to learn how Creyos can improve your clinic’s delivery of mental and behavioral healthcare.

FAQ

Here are a few frequently asked questions about behavioral healthcare:

What is behavioral health?

Behavioral health refers to how a patients’ behaviors are impacted by their mental, emotional, and cognitive health. These behaviors are often exhibited through their habits, lifestyle, social interactions, and coping strategies.

What are examples of behavioral health?

Some examples of behavioral health include:

A person’s behavioral health (AMA, 2022) can refer to their:

• Habits
• Lifestyle
• Social interactions
• Coping strategies
• Mental health and symptoms of severe mental illness
• Cognitive health related to behavioral changes
• Risk assessment

What is behavioral healthcare?

Behavioral healthcare is a specialization that focuses on the impact of mental health and substance use disorders. It addresses the physical and psychological symptoms of these conditions, as well as the social factors of mental illness.

Preventative care and the implementation of specialized treatment plans are necessary factors for delivering behavioral healthcare. This model also includes collaboration between providers such as physicians, psychologists, psychiatrists, and social workers.

Why is behavioral healthcare important?

Behavioral healthcare is important because of its positive effect on patients’ health outcomes, as well as providers’ capacity to provide high quality healthcare.

Implementing integrated behavioral healthcare:

• Increases the speed of diagnoses and treatment for patients
• Saves long-term costs for patients, clinics, and the overall healthcare system
• Improves collaboration between healthcare providers

Including Behavioral Healthcare in Primary Care  

Normalizing cognitive and mental health assessments, as well as strengthening communication across the primary care team, are the first steps in helping patients with behavioral health conditions. 

Integrating behavioral care services into primary care has proven benefits for patients and providers. Contact us to learn more about how the Creyos healthcare platform can facilitate behavioral healthcare in your practice.