An annual average of 1.5 million young adults do not receive needed mental healthcare services, in part due to cost, stigma and structural barriers, according to a 2015 U.S. Center for Behavioral Health Statistics and Quality report.
To address this issue, some mental health advocates have rallied around integrated behavioral healthcare, an emerging form of coordinated care. Integrated behavioral healthcare, according to the U.S. Agency for Healthcare Research and Quality, brings together a team of primary care and behavioral health clinicians, in an effort to improve patient 
outcomes.
"The premise is rather simple," says David Lim, MD, PhD, chief medical officer at Quartet. "If you help support patients to get happier, they end up getting healthier."
Quartet, a New York City-based software startup, was founded in 2014 to bridge the gap between primary care physicians and mental health providers. Through its web portal, concerned primary care physicians can flag certain patients, which enables the Quartet team to conduct behavioral health screenings and, if appropriate, connect patients with local mental health providers.
Here are three thoughts Dr. Lim shared with Becker's Hospital Review about the need for integrated behavioral healthcare.
1. For many, mental health is a new consideration. "Mental health has probably been the least developed sector of healthcare," Dr. Lim says. "This is for multiple reasons, a lot of which really deals with the fact that there's so much social stigma."
Until the Mental Health Parity and Addiction Equity Act of 2008, health insurers were not required to cover mental healthcare at the same level as physical or surgical care.
"We haven't really elevated the field of mental health conditions to become on par with things as simple as strep throat, or as simple as the common cold, when we really should be addressing them," Dr. Lim says.
2. Many physicians hone in on their specialty — but overlook related issues. "A lot of the healthcare system is so keenly focused on addressing the physical health problems of patients, without being equipped to look for and address the behavioral health conditions," Dr. Lim says. "But there's a whole sector of patients that silently suffer."
For Dr. Lim, a former HIV specialist, an important function of integrated behavioral healthcare is acknowledging how patients with chronic conditions often have underlying mental health issues, such as anxiety, depression or substance use disorder. In particular, mental illness is associated with diseases such as cardiovascular disease, diabetes and obesity, according to a 2011 CDC report on mental illness surveillance.
"A patient who's recently diagnosed with diabetes, or HIV, or any chronic health condition, should probably have a mental health follow-up," Dr. Lim says. "It's a life-altering diagnosis, a life-changing event, and they're going to need support."
Advanced analytics can help identify patients in need of mental health resources, by highlighting behavioral health gaps early in the care process. "If you had a patient who was admitted to a psychiatric ward, and then they were discharged, but never went to a psychiatrist for follow-up, that's a clear gap that needs to be closed," Dr. Lim says.
"Or, we can even look at the prescription data: If there's a patient who is on three antipsychotics at the same time — for, say, over two months — that clearly is not optimal."
3. Even a physician who notices mental health symptoms may not be aware of best practices. "A lot of times, PCPs will recognize a patient who is suffering from behavioral health conditions, but probably too late — they'll be weeping in the office, or they'll be telling the PCP quite openly, 'I'm suffering from intense anxiety,'" Dr. Lim says.
Unfortunately, primary care physicians and mental health providers do not typically work together to coordinate care, according to Dr. Lim. This fragmented environment often leads primary care physicians to provide patients with outside resources to call, Dr. Lim says, rather than engaging with patients to create and assess a long-term mental health plan.
In part, Dr. Lim attributes this reluctance to engage in mental healthcare to lack of training. "This is a paradigm shift for healthcare," Dr. Lim says. "We may say to ourselves, 'Mental health is not what I trained to do. It's not a part of my purview.'"
Once a high-need patient — who is receptive to mental health services — has been identified, the Quartet team uses its web portal to open up communication between the patient's primary care physician and their new mental health provider. This type of discussion can also help deepen primary care physicians' understanding of behavioral health.
"We are trying to change the tide here, to make PCPs and their office staff be more attuned," Dr. Lim says. "To say yes, the patient might be on antidepressants, but are they actually doing better?"