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This chapter describes established models and emerging approaches for integrating primary care and behavioral health services. Although many of the challenges that led to the need for integration initially currently remain, different integrated care models offer a variety of innovative responses to these challenges, with strengths and limitations specific to each model. Although collaborative care models have achieved a strong evidence base, it still requires significant resources to appropriately implement and maintain a high-fidelity program.

Despite a noted patient preference for psychosocial treatments (defined here as psychotherapy, counseling, coaching, and case management), people receiving mental health care in the United States are more likely to be treated with medications than they are with psychosocial treatments. While there are problems with inappropriate use of medications, including both undertreatment and overtreatment, there is little doubt that psychosocial treatments are underused, and that is the focus of this chapter. The disconnect between patient preferences and services used is due to several policy-level factors. There is no shared consensus or viable information source to determine which psychosocial treatments are evidence-based, clinician training is poorly regulated, credentialing and licensure practices often are not competency based, location of care is inconvenient, it is complicated to measure quality of care, and there are no incentives to offer evidence-based treatment. In this chapter, we discuss these limitations and offer examples of successful programs that specifically address these problems. We end with a series of recommendations to policy makers in the United States to ensure patients with mental health challenges are guaranteed access to the treatments they need and prefer.