Behavioral healthcare is a healthcare specialization that focuses on mental health, maladaptive behaviors that affect a person’s everyday life, and substance use disorders. 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.
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.
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.
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 mental component summary (MCS) or mental health subscale of the Short Form Health Survey (SF-36 or SF-12), showed that better mental health was associated with lower mortality risk.
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.
Article Highlights
Behavioral healthcare focuses on mental health, maladaptive behaviors, and substance use disorders, which commonly co-occur: about half of people who experience a mental illness during their lives will also experience a substance use disorder, according to national population surveys.
- Behavioral health integration pairs the primary care team with behavioral health professionals. In one study, 75% of patients in collaborative care reached a diagnosis and began treatment within 6 months.
- One analysis estimates that fully integrating behavioral health with physical care could save the US healthcare system $26–48 billion each year.
- Behavioral symptoms such as apathy, sleep changes, and depression can overlap with early cognitive decline, so pairing cognitive testing with mental health screening can help providers tell the two apart.
What does behavioral healthcare include?
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.
Behavioral healthcare often begins with a comprehensive health assessment for behavior to better understand individual challenges and guide tailored treatment.
Behavioral healthcare can include specialized treatment methods, such as:
- Cognitive behavioral therapy (CBT)
- Dialectical behavioral therapy (DBT)
- Substance use counseling
- Acceptance and commitment therapy (ACT)
- Mindfulness-based cognitive therapy (MBCT)
- Motivational interviewing
- Social services
- Medication management
The co-occurrence of substance use disorders with mental health disorders is common: one review identified up to 66% of patients with substance use disorders reported also having a mental illness diagnosis, of which depression was the most prevalent (57%). Behavioral healthcare services aim to address these comorbid conditions, and build treatment plans that address individual patients’ needs.
What are examples of behavioral health?
Behavioral healthcare identifies the ways in which a person’s behaviors impact and relate to their physical, emotional, and mental wellness.
A person’s behavioral health 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.
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. Integration may relieve any one clinician of the responsibility to manage the many facets of patients’ comorbidities, and helps address mental and physical health in tandem.
Behavioral health integration can also 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. 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. 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 and 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
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 use 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. Physicians can tap into the benefits of social care by connecting with behavioral health specialists who offer social services.
Benefits of integrating behavioral health into primary care
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. In cases of substance use, early intervention is one of the most effective components of successful treatment.
- Reducing stigma around mental health conditions by normalizing conversations about mental illness and substance use disorders.
- Cost saving in the long term. One analysis reported by the American Psychological Association found that fully integrating behavioral health services with physical treatment could save the American healthcare system $26–$48 billion each year.
- 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.
One study in Translational Behavioral Medicine found implementation costs were relatively low for most clinics, at around $20,000 over 24 months.
One evaluation of integrated behavioral health services found savings of $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.
Behavioral health and cognitive care in older adults
According to the World Health Organization, 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, can make signs of cognitive decline difficult to disentangle from symptoms of mental illness.
Behavioral and psychological symptoms of dementia 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.
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 use 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
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. 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.
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.
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 measurable benefits for patients and providers, including faster time to treatment and lower long-term costs. Contact us to learn more about how the Creyos healthcare platform can facilitate behavioral healthcare in your practice.
Reviewed by Mike Battista, Director of Science & Research at Creyos
Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.