Integrating Mental Health in Safety-net Primary Care: A Five-year Observational Study on Visits in a County Health System

BackgroundBeginning in 2010, Los Angeles County Departments of Health Services and Mental Health collaborated to increase access to effective mental health care. The Mental Health Integration Program (MHIP) embedded behavioral health specialists in primary care clinics to deliver brief, problem-focused treatments, and psychiatric consultation support for primary care-prescribed psychotropic medications.ObjectiveThe aim was to compare primary care visits associated with psychiatric diagnoses before and after MHIP implementation.MethodsThis retrospective cohort study (2009-2014) examined 62,945 patients from 8 safety-net clinics that implemented MHIP in a staggered manner in Los Angeles. Patients' primary care visits (n=695,354) were either associated or not with a previously identified or "new" (defined as having no diagnosis within the prior year) psychiatric diagnosis. Multilevel regression models used MHIP implementation to predict odds of visits being associated with psychiatric diagnoses, controlling for time, clinic, and patient characteristics.Results9.4% of visits were associated with psychiatric diagnoses (6.4% depression, 3.1% anxiety