How Integrated Behavioral Health Supports Underserved Populations

In recent years, the term "integrated behavioral health" or "collaborative care" has become increasingly common throughout the health and wellness community. Providers have been gradually moving toward this model, which aims to blend physical healthcare with mental healthcare. This approach aims to provide more comprehensive healthcare to patients and expand mental healthcare services to historically underserved populations.

So, what exactly does integrated behavioral health entail, and how could it help eradicate some cultural barriers in healthcare?

Defining Integrated Behavioral Health

Integrated behavioral health is a "whole-person" care model where patients receive treatment for both physical and mental health needs in one place, including co-occurring disorders. The integrated behavioral health approach eliminates the need for multiple appointments.

The Model of Integrated Behavioral Health

As a healthcare model, integrated behavioral health requires coordination from several key players, including primary care physicians, behavioral health professionals, and other specialists. 

What integrated behavioral health might look like for a patient will vary depending on the context. In many cases, integrated behavioral health will begin at the primary care clinic, where a PCP can provide general wellness services in addition to referrals for behavioral health in-house.

Barriers to Healthcare for Underserved Populations

What does integrated behavioral health have to do with underserved populations? The unfortunate reality is that some populations have been historically underserved, particularly when it comes to access to mental healthcare and substance use disorder treatment.

Economic and Cultural Barriers

Research from Horizon Blue has found that Black Americans, American Indian Americans, Hispanics, and members of the LGBTQ+ community are more likely to experience severe mental health conditions, at least partially due to inherent barriers to mental health and addictions treatment. Likewise, those without health insurance or those of a lower economic status may have a hard time affording healthcare when they need it—even if they do have insurance coverage.

Geographic and Transportation Barriers

Consider the geographic and transportation barriers that can complicate access to healthcare. For those without vehicles, even getting to an appointment for a basic wellness exam can be a challenge. When the same patient needs to make a separate appointment at a completely different location to get help with a mental health or substance related disorder, this can make things even more difficult.

Role of Integrated Behavioral Health in Addressing Healthcare Disparities

As part of the innovative health services that encompass integrated behavioral health, it may be possible to overcome common barriers to mental health and substance use disorder treatment and provide more comprehensive care to all populations.

Comprehensive Care

For starters, when patients can more conveniently secure behavioral health services during routine healthcare appointments (such as during annual wellness exams), it is possible for these patients to receive more comprehensive care.

Preventive Care and Early Intervention

When behavioral health services can be more readily offered at routine appointments, this type of care can become more preventative rather than reactive. This early intervention can result in better patient outcomes while making behavioral healthcare more accessible for all populations, regardless of the social determinants of mental health.

Strategies for Implementing Integrated Behavioral Health

Of course, actually implementing the model of integrated behavioral health into existing healthcare systems can be easier said than done. Fortunately, some tried-and-true strategies make it easier to overcome historical healthcare access issues.

Policy and Funding

There is a growing need for changes to existing policy, especially regarding the funding healthcare facilities receive to implement integrated behavioral healthcare services. More primary care offices and similar facilities need financial assistance to bring behavioral health specialists—those trained in treating individuals with co-occurring disorders—and other professionals on their staff.

Community and Stakeholder Engagement

Meanwhile, community members affected by these healthcare decisions and stakeholders need to be as engaged as possible in access to mental health, substance use, and co-occurring disorder services. For advocates of integrated behavioral health, this means spreading awareness of policy changes and funding for mental health, substance use, and co-occurring disorder services needed to improve access.

Counselor Education Training in Social and Cultural Diversity

To serve diverse populations, counselors may require additional education and training to provide optimal care.

Cultural Competency Training

Cultural competency in healthcare begins with being able to provide culturally sensitive services that consider a patient's unique and diverse background. With this in mind, many facilities incorporating behavioral health into their offerings are requiring their counselors to go through cultural competency training.

Addressing Implicit Bias

Another issue gaining more awareness in behavioral health is implicit bias. The American Psychological Association defines implicit bias as when a person's deep-rooted beliefs or experiences unknowingly affect the way they see others. In a behavioral healthcare setting, implicit bias can affect the quality of care that patients receive. This is why it is so important to address it in an integrated behavioral healthcare system.

Enhancing Communication Skills

In some cases, communication and language barriers may contribute to gaps in care, which is why healthcare and behavioral health providers in an integrated system need to have active listening skills, know when to include an interpreter, and have other types of communication skills critical to serving diverse populations.

Challenges and Solutions

As the healthcare field aims to move toward a more integrated model of care, there are some inherent challenges and solutions that will need to be overcome. One key challenge is the need for more diverse representation within the counseling profession. Recruiting and training counselors from diverse backgrounds are essential to ensure that patients have access to therapists who not only look like them but also share similar life experiences and cultural backgrounds. This can help build trust and foster a stronger therapeutic relationship, particularly for individuals from underrepresented communities.

Addressing this gap requires intentional efforts in both recruitment and education, making careers in counseling more accessible to individuals from diverse racial, ethnic, and cultural groups to pursue careers in counseling. 

Navigating Policy Limitations

For starters, limitations on insurance coverage are a common and growing issue that will need to be addressed. Behavioral healthcare services are not always covered by insurance, but as mental healthcare becomes more accessible across the board, this needs to change.

Ensuring Sustainability

Meanwhile, healthcare facilities must ensure the long-term sustainability of integrated behavioral health programs. Plans can include reducing the stigma surrounding mental healthcare and addiction and improving patient and provider retention.

Future Directions in Integrated Behavioral Health

Only time will tell what the next several years will look like for integrated behavioral healthcare, but some trends are already evident.

Technological Advancements

First, technological advancements are making integrated behavioral health more attainable than ever before. Innovations like telehealth and behavioral health can take place in a virtual setting, which can reduce costs and be a win-win for all involved.

Expanding Scope and Reach

More community health initiatives are moving toward a more integrated behavioral health model. Expanding the scope and reach of these programs can provide more patients with the behavioral care they need for mental health disorders, substance abuse disorders, and more.