Examples of potential primary care integration and prevention noted by Shim and colleagues include providing behavioral health screening such as with the nine-item Patient Health Questionnaire (PHQ-9) for depression or the screening, brief intervention, and referral to treatment (SBIRT) for substance abuse.  Further efforts might involve the use of mental wellness coaches and behavioral change experts inpatient-centered integrated care settings.

The authors suggest that psychiatrists and primary care providers could collaborate on culturally and developmentally sensitive methods of screening for risk factors and adverse health behaviors such as substance abuse, domestic violence, and firearm ownership. In addition, by using a developmental perspective, psychiatrists could provide primary care-based interventions focused on enhancing strengths and protective factors among children, youth and their parents.

While the Affordable Care Act offers opportunity, the authors recognize the extent of change and suggest a note of caution, saying that “Expanding psychiatric services to incorporate prevention within a primary care setting will require a paradigm shift that challenges the way psychiatry has historically been practiced.”

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis,treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at www.psychiatry.org.