"My primary care patient is experiencing depression. Should I recommend the patient be seen by the behavioral health consultant (BHC) in primary care? Or should I refer the patient to the specialty behavioral health clinic? What’s really the difference?”
The Military Health System (MHS) has various levels of care available for patients with behavioral health concerns. Clinicians in the MHS may have questions about which level and location of care is right for a particular patient: primary care behavioral health (PCBH) or specialty behavioral health services.
Integrated within primary care clinics, BHCs are licensed psychologists or social workers who assist primary care teams in the care of patients with a wide range of conditions and concerns. BHCs work with patients who would like to make changes to better manage their health, adjust to life changes, improve adherence to their primary care manager’s (PCM’s) treatment plans, or address behavioral health conditions or symptoms. BHCs provide focused, evidence-based assessment and intervention in appointments that are no more than 30 minutes in length. Many patients see the BHC for one or two visits; others engage in longer courses of care spaced out over time. BHCs typically work with patients until symptoms or functioning begin to improve, at which point care is continued by the primary care manager, who reinforces strategies that have been helpful and monitors the condition over time.
If the patient does not improve with interventions at the primary care level, the BHC can link the patient with a higher level of care in a specialty behavioral health clinic for a comprehensive assessment and full course of psychotherapy. In specialty behavioral health, appointments are typically longer in duration (e.g., 50 to 60 minutes). Assessment may include a comprehensive battery of psychological tests and integration of information from various sources. Evidence-based psychotherapy may include weekly or bi-weekly appointments delivered over longer courses of care (e.g., 10 to 12 appointments). Patients are often seen in specialty behavioral health care until symptoms have remitted. When specialty behavioral health care is no longer needed, patients may still benefit from periodic visits with their primary care clinic’s BHC to assist with maintaining gains and preventing relapse.
In considering level of care decisions, a PCM may wonder: “If I think my patient needs specialty-level care, should I still send them to the BHC?” Sometimes it is clear that a patient would benefit from a higher level of care. For example, a patient with serious mental illness or a need for more complex psychotropic medication management may have needs best addressed in specialty behavioral health. While PCMs can bypass the BHC in these situations, there is often value in discussing the case with the BHC and potentially involving the BHC in care. BHCs can work with patients to increase willingness to accept a referral to specialty care, can address barriers that may interfere with accessing care, and can provide care to bridge gaps until a specialty care appointment is available and attended.
Learn more about primary care behavioral health and the role of BHCs on the Psychological Health Center of Excellence website.