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Primary Care Behavioral and Specialty Behavioral Health

While BHCs DO provide evidence-based intervention appropriate for a primary care setting for a wide variety of clinical problems, BHCs MUST NOT provide specialty behavioral health treatment or carry a specialty behavioral health caseload in the primary care setting. Find a description for BHC services on the PCBH Personnel page.

Conceptual Distinctions of Primary vs. Specialty Behavioral Health Care Models

Dimension Behavioral Health Primary Care Specialty Mental Health
Model of care Population-based Client-based
Primary consumer PCM Client
Primary goals Enhance the primary care team’s ability to manage and treat behavioral health problems and biopsychosocially-influenced health conditions, with resulting improvements in primary care services for the entire clinic population Resolve client's mental health issues
Service delivery Team-based; part of primary care services A specialized service, either in or out of primary care
Leader of care BHCs support the PCM, who is the lead provider Therapists serve as the lead provider for the given intervention
Course of care Engage in care as needed over time Discrete periodic episodes of treatment are opened and closed
Accessibility On-demand, easy access for new patients Accessibility may be limited by full caseloads of existing clients
Appointment length No longer than 30 minutes 50- to 60- minutes, often longer for initial visit
Treatment plan


Shared Separate
Patient volume High Low
Follow-up duration Follow patients until they have a plan and start to improve Follow patients until remission

Transitioning Patients Between Primary Care and Specialty Mental Health

Some patients seen in primary care need a higher level of care than can be provided through primary care behavioral health (PCBH) services. Primary care managers (PCMs) may refer higher acuity patients directly to specialty mental health or substance abuse clinics (either within the military health system or in the TRICARE network). It is recommended, however, that PCMs first link the patient with the primary care clinic’s behavioral health consultant (BHC) to help facilitate a successful transition to specialty mental health care. The BHC can work with patients to increase readiness or willingness to access care, and assist with addressing barriers to care that may arise. If there is a significant delay in access, the BHC may continue to meet with the patient to bridge any gaps in care. Finally, the BHC can assist with coordination and communication by sharing relevant information with the gaining mental health care provider.

Connecting to the BHC When a Patient Declines a Referral to Specialty Mental Health

Not all primary care patients may be willing to access specialty mental health care. This reluctance can stem from different sources, such as stigma, concerns about impact on military career, cost (Tricare co-pays for some beneficiaries), time required for treatment, lack of belief in the potential benefits of mental health treatment, or one or more of many other reasons. BHCs can identify which barriers to accessing specialty mental health care are relevant for a particular patient. They can work with patients in one or more focused appointments to help address identified barriers and increase willingness to access care. Interventions might include education about mental health disorders and treatment, motivational interviewing, or problem solving approaches. The BHC can continue to monitor the patient’s symptoms and assess and address suicide risk during transitions in care.

Last Updated: November 30, 2023
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