Integrated Behavioral Health Works and Saves Money. Why Aren’t We Doing It?  

You’re in a pediatric clinic waiting room with your son Liam. He’s been having a tough time lately. The nurse calls you both in and finds that Liam’s scores on the depression and anxiety screeners are high. Your doctor gives you a referral for an in-network therapist who can work with Liam further. After you get home and call the therapist, you find that the next available appointment is not for six months. There’s an out-of-network therapist available sooner, but you can’t afford it. In the meantime, your son’s symptoms are getting worse.  

This is an unfortunate reality for many families, but it doesn’t have to be this way. 

Instead, imagine that you and Liam walked into a pediatric clinic. He’s seen first by the doctor but this time, the doctor brings in a colleague who is a behavioral health clinician and member of Liam’s care team. This clinician spends 30 minutes with you both in the same room where you just met with the doctor. The clinician talks with you about specific behavioral changes that Liam can make and sets up a follow-up appointment. Before you and Liam leave, the clinician checks in with the doctor to update the care plan.  

In a clinic with integrated behavioral health, a child with any indications of behavioral health needs is given holistic care right away. While it is not the standard of care today, there are actions that state policymakers and health systems can take to help ensure integrated behavioral health is available in every primary care clinic serving individuals of all ages. 

What is the State of Behavioral Health in the US? 

The United States is experiencing a serious behavioral health crisis. Behavioral health is an umbrella term that includes mental health and everyday behaviors that affect overall health. Nearly 25% of adults and 50% of adolescents live with a mental illness. Yet many lack access to behavioral health care. Of the one in five youths who experienced a major depressive episode, more than half did not receive treatment. Of the 18% of adults who suffered from substance use disorder, 77% did not receive treatment.  

It is estimated that mental illness costs the U.S. economy over $280 billion annually, impeding productivity and inhibiting progress both for individuals’ career trajectory and for broader economic growth. In 2023, the U.S. Preventive Services Task Force began recommending universal screening for depression and suicide risk and anxiety for adults. But there remains much to be done. Specialty behavioral health treatment is exceptionally hard to come by in the United States; the ratio of people to mental health providers is 340:1. Integrated behavioral health is primed to be a solution to this growing emergency. 

What is Integrated Behavioral Health?   

In integrated behavioral health (IBH), medical and behavioral health clinicians work as a team, recognizing that the head and the body should not be treated separately. IBH aims to enhance access to behavioral health services in primary care settings, where 75% of visits include a behavioral health component. 

The two most common models of IBH, depicted in the Figure, are the Collaborative Care Model (which embeds a care manager and includes a psychiatric consult often focused on depression, anxiety, and substance abuse) and the Primary Care Behavioral Health Model (which embeds a behavioral health clinician and is also focused on managing chronic conditions like diabetes). While these models are great guides, we urge leaders to innovate, as IBH works best when it is selected and adapted based on the needs of specific patient populations. 

Overview of Two Common Integrated Behavioral Health Models 

IBH is associated with a decrease in behavioral health issues and improved physical health. Other benefits include fewer ER and hospital visits, improved patient and clinician satisfaction, decreased if not eliminated wait times, and less mental health stigma.  

IBH is recognized as high-value care by the American Hospital Association, American Academy of Family Physicians, and American Psychological Association. Additionally, researchers estimate that IBH could cost as little as $20,000 per practice and save the United States $38 to $68 billion in health care spending annually. 

Why Isn’t IBH the Standard of Care? 

Although IBH is long recognized as valuable to both patients and providers, efforts to translate IBH into practice in the last 20 years were often stymied by organizational, attitudinal, and financial challenges. Our recently published study of New Jersey federally qualified health centers and community health centers identified ways to address these challenges (see Table) within the existing rigid medical system. To widely adopt IBH, there will need to be system-level shifts and leadership that prioritizes holistic care. 

Table. Challenges to Implementing IBH and Workarounds 

Note. EHR = electronic health record; IBH = integrated behavioral health; RVU = relative value unit. 

Where Do We Go From Here? 

What can policymakers do? We must first acknowledge the fact that health systems need to generate revenue and that, despite being the key pillars of prevention and treatment, primary care and behavioral health care have among the lowest reimbursement rates. The financial situation is made more dire by ongoing federal budget cuts, including the CMS Innovation Center’s early termination of several primary care demonstration projects in March 2025. 

We call for policymakers to increase reimbursement rates for primary and behavioral health care. CMS and payers alike need to start prioritizing prevention to reduce utilization of more expensive care down the road. “If America truly wants to cut unnecessary spending, it must invest in not only primary care but also integrated behavioral health,” stresses Alfred Tallia, MD, MPH, chair of Family Medicine and Community Health at the Rutgers Robert Wood Johnson Medical School. This prevention-first approach is road-mapped further in the National Academy of Medicine’s 2021 report. Think of it this way: If a patient like Liam learns cognitive behavioral therapy techniques in his early teens, he could better manage his symptoms of depression and anxiety and may be less likely to need the ER or specialty care. 

What can health systems do? Health systems can start investing in primary care practices that are interested in starting and sustaining IBH programs. Upfront funds are needed to hire IBH-focused behavioral health clinicians, support workflow re-design and training, and update EHR systems to include IBH documentation. Cost-benefit analyses (e.g., expense ratios) are also recommended to help negotiate better reimbursement rates. 

At the same time, systems can incentivize their leaders to partner with state agencies and seek grant support to extend IBH initiatives. For example, in 2024, the New Jersey Division of Mental Health and Addiction Services and the Rutgers Center for Integrated Care worked together to get a competitive $4.5 million grant from the U.S. Substance Abuse and Mental Health Services Administration to incorporate the Collaborative Care Model into three primary care practices. 

Health care stakeholders should strive to establish IBH as the standard of care sooner rather than later — so that kids like Liam can access timely, patient-centered care and not risk falling through the cracks. Moreover, IBH results in real cost savings and makes patients and clinicians happier. We call, then, for a collective effort to make IBH a priority and a reality for all.