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This guest post was contributed by Dr. Virmarie Diaz-Fernandez, Clinical Advisor of Peregrine Health—a TPCA Partner.

In most communities, especially rural and underserved ones, primary care providers (PCPs) are the de facto mental health system.

 
Not because they’re trained to be, but because they have to be.

 
With a national shortage of behavioral health (BH) providers, limited referral options, and persistent stigma around mental illness, patients often turn to their PCP for help. The problem? Most PCPs are stretched thin, appointments are short, and they often lack the time and confidence to fully assess mental health concerns. Many work in systems not built to support integrated care.

 
This mismatch, between what patients need and what providers are equipped to deliver, is one of the most urgent gaps in healthcare today.

 
Why PCPs Are Being Asked to Do Too Much

Primary care appointments typically last 15–20 minutes. In that time, a PCP is expected to manage everything from blood pressure checks to diabetes control, and increasingly, depression, anxiety, and trauma.

 
PCPs want to help their patients, but:

• They aren't trained mental health specialists
• They lack access to real-time support from behavioral health professionals
• Referral networks are limited, especially in rural and safety-net settings
• Many clinics want to keep care in-house, but don’t have the infrastructure to do so effectively

 
Additionally, the fast-paced nature of primary care makes it difficult to stay up to date on evolving best practices in mental health care, which can impact provider confidence and patient outcomes. This leads to a dangerous cycle where mental health concerns go undiagnosed, untreated, or mismanaged, worsening both mental and physical outcomes.

 
The Stakes Are High and Rising

When mental health issues are missed or left untreated, the ripple effects are profound:

• Patients with depression or anxiety are less likely to manage chronic conditions like diabetes, hypertension, or asthma
• Mental health disorders are linked to higher ER usage, disability rates, and mortality
• Care teams become overwhelmed trying to manage crises they aren’t equipped to handle
• Untreated mental health issues can significantly reduce a patient’s quality of life and increase their risk of developing additional physical health problems

 
For clinics that serve underinsured or Medicaid populations, especially Federally Qualified Health Centers (FQHCs), these gaps lead to higher costs, staff burnout, and poor population health outcomes.

 
Integration Is the Answer, But It’s Not Easy

Integrated behavioral health is a proven model. It works by embedding BH professionals directly into the care team, enabling PCPs to screen, refer, and co-manage patients with support, not in isolation.

 
Benefits of integration include:

• Early identification and intervention before crisis escalate
• Reduced stigma by normalizing mental health in the primary care setting
• Improved continuity between physical and mental health care
• Better clinical outcomes and higher patient satisfaction
• A more holistic, patient-centered approach that fosters trust and communication between patients and providers

 
But integration takes more than goodwill. It takes:

• Investment in staff, hiring, training, and supporting BH providers
• Workflow redesign, from scheduling to documentation
• Reimbursement know-how, navigating grants, billing codes, and value-based models
• Space and infrastructure, especially hard to find in small or resource-strapped clinics
• A cultural shift that encourages collaboration across disciplines

 
What It Takes to Build a Sustainable BH Program

To move from idea to impact, clinics need support across five key areas:

• Staffing: Recruiting and retaining licensed BH professionals, even in tough markets
• Training: Equipping both medical and BH teams with collaborative care skills, while also boosting confidence in identifying and managing mental health needs
• Infrastructure: Creating physical and digital environments that support integration
• Sustainability: Building models that work within FQHC funding and reimbursement structures
• Patient engagement: Making mental health part of the culture, not an add-on

 
A Foundation for Future Growth

Once core behavioral health services are integrated, clinics are better equipped to expand into more advanced programs. With the right staffing, workflows, and collaboration already in place, adding services like Medication-Assisted Treatment (MAT), care for serious mental illness, or trauma-informed approaches becomes far more achievable.

 
Integrated care creates the clinical and operational infrastructure needed to take on more complex needs without overwhelming providers or disrupting daily operations. It also positions clinics to succeed in value-based care environments by improving patient outcomes, care coordination, and reimbursement potential.

 
Integration helps primary care shift from reactive crisis management to proactive, whole-person care—treating both mental and physical health in a coordinated way. It’s not just a response to current access challenges; it’s a long-term strategy for delivering truly comprehensive care.

 
The Bottom Line

PCPs shouldn’t have to carry the mental health crisis on their own. And patients, especially in communities with the least access, deserve better than fragmented, inconsistent care.

 
Behavioral health integration is no longer a nice-to-have, it’s a necessity.

 
And with the right support, it’s possible.

Interested in how Peregrine Health can support your team in integrating a behavioral health service line? Visit www.peregrinehealth.com to learn more.