Implementation of Integrated Behavioral Health Care in a Large Medical Center: Benefits, Challenges, and Recommendations

Emotional Support for Infertility Patients: Integrating Mental Health Professionals in the Fertility Care Team

“…Underutilization and difficulty accessing mental health services in the United States is not unique to fertility patients, as less than half (43.3%) of the 47.6 million adults with mental illness accessed mental health services in 2018 [23]. Stigma, cost, time, and inability to navigate establishing mental health care are some of the reasons why patients may not seek or receive needed mental health care.…”

“…The greater uptake of patients receiving psychological treatment as a result of embedding MHPs in a medical care team appears to be driven by patient trust in their medical provider's recommendation to seek care with a MHP who is well known to the provider, reduced stigma surrounding behavioral healthcare as a result of integrated care, having a "warm handoff" to an MHP from a medical provider, greater awareness of insurance coverage for "in-house" MHPs, and reduced wait time in searching for and obtaining support from an external MHP who may or may not be taking new patients or be in-network with their insurance provider [22,23]. It is for these reasons that The Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services has made its mission to reduce the toll of mental health conditions in America, in part through the integration of MHPs into medical clinics [46].…”

“…In addition to patient benefits, the integration of MHPs in medical clinics has also been associated with reduced medical team burden due to team members' perception of greater support, reduced patient-patient related stress, increased confidence in the ability to manage patients mental health needs, direct and easy access to mental health experts for mental health related questions and recommendations, and improved understanding of patients' needs all of which result in improved delivery of patient centered care and patient satisfaction [23]. Easy access to embedded MHPs also enables immediate activation of support during in-clinic patient crises (e.g., panic attacks, suicidal ideation, scans revealing pregnancy losses) and MHPs can provide didactic education and training to staff and trainees [47].…”

“…To implement the incorporation MHPs in the care team, acceptance and adoption of system-wide change is often necessary [23]. An adaptation framework by Prom et al, suggests the inclusion of these management-based strategies: recruitment of practice stakeholders, providers and staff champions; early engagement of administrators, providers, and staff with a focus on buy-in, clearly communicated values, mission, and goals; and long-term engagement of providers and staff that is centered on feedback and reducing perceived barriers and challenges [23]. SAMHSA also provides numerous resources related to the integration of behavior health services into medical settings [48].…”

“…Multiple studies outside of reproductive medicine have demonstrated how embedding mental health providers (MHPs) within the care team may result in improved patient satisfaction, psychological distress, and adherence to medical treatment [22][23][24][25]. Additionally, research with infertility patients has shown that patient-perceived barriers to mental health care (e.g., the need to travel long distances for mental health care, insurance coverage for care) may limit patients' use of formal mental health support [10,11].…”