Mental health and primary care in an HMO

The first phase of a multi-year project to integrate primary care and mental health in a staff-model HMO included a qualitative baseline evaluation. Two components of the mental health delivery system were evaluated: 1) the traditional separate system and 2) a health psychology pilot program. Focus groups were conducted with: health psychologists; physicians from clinics with health psychologists; physicians from clinics without health psychologists; and other front-line clinic staff (RNs, LPNs, receptionists). In the traditional, separate system, there is a communication gap between primary care and mental health, physicians perceive an access problem, and there is little collaboration. Physicians who work on teams with health psychologists describe advantages in terms of communication, access, and collaboration. However, because the health psychology pilot program operated in only a portion of a very large care system, it has thus far had only a minimal effect on the way care is delivered in the overall system.