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Primary Care Behavioral Health (PCBH) and the Coronavirus

Thursday, March 12, 2020   (0 Comments)
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Written By: Dr. Phillip Hawley, PsyD

Primary Care Behavioral Health Director for Yakima Valley Farm Workers Clinic



I hate to spoil good click bait, but Behavioral Health Consultants (BHCs) do not directly treat viruses within the PCBH model of behavioral health integration. What we do is make primary care better!


As coronavirus information, increased testing, and confirmed cases fill our news feeds, inboxes, and minds we all still have to do all the other requirements that we were discussing prior to the COVID-19 outbreak. This means that with increased focus on COVID-19 we still need to improve access, screen for depression, screen for substance use disorders, teach parenting skills, and lower health risk in all of our patients. That’s why PCBH and BHCs are so crucial to efficient population health strategies.


Within our organization we survey providers at each BHC’s annual evaluation and this has unanimously revealed that providers are able to work more efficiently when there is a BHC at their clinic. When BHCs are not present I hear from our providers about it. “How can I do my job when we don’t have a BHC here?” is a common response whether we are talking about opening a new clinic, filling a vacant position, or even when a BHC is out for just a few days.


As our primary care providers are doing what they do best in treating the front lines of medicine, we also need to step up and take on the work of talking with patients about behavioral health so our providers have extra time during this current situation. Through my experience of working in primary care I have seen that many medical providers are excellent in discussing smoking cessation, sleep hygiene, and even differentiating between bipolar disorders and depression.


However, BHCs can also do these things to ensure that our medical staff can do the things that BHCs will never do; treat infectious diseases. This teamwork and coordination is why the PCBH model provides a population based approach to care and emphasizes the values of “treat all patients”, “meet patients where they are at”, and “same day behavioral health access”.


In other models of integrated primary care, providers are still relied on to address the majority of patients who receive their behavioral health treatment in primary care (Wang et al., 2005). Insurances, diagnoses, age requirements all pose as barriers not only to patient care, but to primary care provider time and attention. When this time is consumed in conversations that can be handled by BHCs it slows down the entire process and ultimately leads to inferior care across the board.


This type of inefficiency is particularly problematic when we are talking about COVID-19. Accurate and rapid recognition has been the difference between success stories and large scale quarantines which are currently playing out across the globe.


Behavioral health will not take a time out for the coronavirus! People will still suffer from anxiety, depression, have their first psychotic break, relapse on substances, and even commit suicide while the world shifts its attention to this virus. The job of all integrated behavioral health providers is to ensure that those with behavioral health conditions do not go forgotten while our medical staff emphases their own strengths.


Team based care is on full display right now as we attempt to balance long term and chronic health with an emerging new disease. Analogous to many visits with patients we currently have an opportunity to be preventative with something difficult and even though increased effort and work is not comfortable, waiting until this gets worse to try and make a change will only result in bigger problems.


As you all think about your role and ways to help keep us all moving forward please remind yourself and everyone around you to wash your hands and don’t forget to use your BHC.




 Wang, P.S., Lane, M., Olfson, M., Pincus, H.A., Wells, K.B., & Kessler, R.C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 629–640. http://dx.doi.org/10.1001/archpsyc.62.6.629





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