Voices of U of U Health
Same-Day Behavioral Health Integration, A Game-Changer for Providers and Patients
By Marta “Teresa” Lopez, LCSW
Mental health affects us all daily, yet most primary care providers don’t have the time or capacity during quick visits to fully address it. That doesn’t have to be the case for providers at University of Utah Health.
Embedding Social Workers Into Clinical Practice
Thanks to the Behavioral Health Integration Program at Huntsman Mental Health Institute at the University of Utah, social workers are embedded in every primary care practice. The program bridges the gap for patients in need with same-day behavioral health support during an already-scheduled clinic visit.
Social workers are also embedded in specialty clinics like gynecology and neurology. And virtual behavioral health consultations are available to patients in dozens of outpatient specialty practices, including cardiology and rheumatology.
Providing same-day behavioral health care to patients on such a wide scale is unheard of in most health systems. That’s what makes our program so unique. Providers can administer a brief mental health screening to patients. If a patient admits stress, anxiety, or depression, the provider can bring a social worker to the exam room at the end of their appointment. The social worker listens and provides strategies and resources to help the patient.
Reducing Behavioral Health Stigma, Getting Ahead of the Crisis
Seeing a primary care provider for behavioral health treatment normalizes the experience, reducing stigma. Because the intervention happens in primary care, patients don’t need to navigate the complex system of behavioral health referrals and insurances.
By partnering with medical providers, we’re treating the whole patient. And same-day access to care helps to avert crises before they happen.
An Extended System of Care
I oversee a team of 35 behavioral health integration social workers at U of U Health. We are integrated into primary care and specialty settings at 15 sites in six counties. Our goal is to work with people until they are feeling well enough to function on their own without more extensive support.
As embedded social workers, we treat episodes of care and offer brief, problem-focused sessions that target causes of stress. We meet with the patient for 30 minutes to discuss how symptoms are affecting their ability to function, and we teach them coping skills.
The support we offer is flexible, based on the targeted problem for each episode. In some cases, one visit is enough. In others, multiple sessions are needed. If a patient requires more care, we refer them to different providers. We have bachelor’s-level social service workers vetting external community resources, so social workers can connect patients to reputable programs.
Setting the Bar for Behavioral Health Integration
The Behavioral Health Integration program recently celebrated its 10th anniversary. When the program began in 2015, I was one of the four original social workers embedded in primary care clinics. Providers were seeing more and more patients who also had mental health conditions. They recognized the need for bringing behavioral health professionals into their practices. They reached out to Huntsman Mental Health Institute for help and oversight.
Through trial and error, we quickly learned a 60-minute therapy model did not work for fast-paced primary care settings. We assessed the industry for best practices, then consulted with Cherokee Health Systems (since renamed River Valley Health) in Tennessee. We adopted their 30-minute behavioral health consultant model, which we still use.
The demand for on-site support was so great, the program doubled in size after one year. When the medical specialties at University Hospital approached us for help in 2017, we expanded our program further.
Initially, behavioral health integration was a no-cost service. But as the program continued to grow, that was no longer sustainable. In 2020, we restructured processes and began billing for our work.
U of U Health was the first health system in the Mountain West to embed social workers. We have since helped Intermountain Health and Wasatch Pediatrics launch similar programs. Expanding the reach of same-day mental health care benefits patients everywhere.
Broadening Our Impact
In recent years, we’ve launched new programs to have even greater impact:
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Universal depression screening. Since 2023, every patient scheduled to see a medical provider receives a questionnaire through MyChart 48 hours before their appointment. If their responses indicate that they could benefit from behavioral health support, our team reaches out. We do more than 4,000 outreaches annually.
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Collaborative care. This is an evidence-based and team-based approach. Primary care providers, behavioral health clinicians, and a consulting psychiatrist work together to support mental health within the primary care setting. Consulting psychiatrists review medications being prescribed to patients with depression and anxiety and make recommendations. Billing goes through primary care, benefiting patients without psychiatry access.
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“You Matter.” Last month, we launched the “You Matter” outreach program for patients discharged from inpatient facilities at Huntsman Mental Health Institute or U of U Health emergency departments after treatment for suicidal ideation, suicide attempts, or crisis evaluation. Our case analysts have multiple touchpoints with every patient: 48 hours after discharge, 7-10 days after, one month after, and 3-6 months after. They screen for suicide risk to reduce recidivism. We provide this ongoing support because research shows suicide attempt rates rise when more time passes after inpatient discharge. We’ve already helped patients who were acutely suicidal after 48 hours get back into treatment. The program was named intentionally, so people know that we continue to care about them after they leave.
A Better Way to Alleviate Providers and Meet Patient Needs
Only a fraction of primary care providers at the U regularly use our same-day services. Some refer patients for behavioral health care, possibly because they’re accustomed to referring patients for lab work. But that keeps patients from accessing this valuable, embedded behavioral health resource.
Patients who are brave enough to admit they have a mental health concern are often ready to talk to someone, and our embedded social workers can meet with them right away.
Patients who receive behavioral health referrals might wait weeks to see a provider. If they are not experiencing the same stressors, they might cancel or no-show. We lose lots of patients that way.
We want to reach patients where they are, when they are open to talking about their feelings. If they are ready for help, we want to provide it.
