WASHINGTON -- Behavioral health care within the Army has historically been provided through several relatively separate service delivery systems. Primary care managers (PCMs) in Military Treatment Facilities (MTFs), have provided the majority of behavioral health treatment. However, for a variety of reasons, they were often limited to prescribing medications and/or referring patients to the civilian network. A smaller proportion of individuals with behavioral health problems were treated in military specialty behavioral health clinics. Limited access at many of our behavioral health clinics resulted in a significant number of family member enrollees receiving specialty behavioral health treatment through the private sector.

Primary care has undergone significant transformations in recent years with the creation of the Army Patient Centered Medical Home (PCMH) which focuses on readily accessible, comprehensive, in house, patient centered care. In the winter of 2010, the Army mandated the implementation of PCMHs across Army Medicine which included the requirement for all medical homes to provide integrated behavioral health services. The medical home has continued to transform over the past couple of years, now called the Army Medical Home, with Community Based Medical Homes in the neighborhoods where beneficiaries live and Soldier Centered Medical Homes for active duty Soldiers only.

"A large percent of our patients suffer from behavioral health symptoms at some point in their life. Unfortunately, for some people these symptoms won't be identified or treated until they begin to have a significant impact on the person's life. Being able to identify those symptoms early and offering appropriate treatment in a timely manner could potentially lead to a reduction of more serious symptoms down the road," explains Commander (Dr.) Aditya Bhagwat, the Program Manager for Primary Care Behavioral Health, in Army Medical Homes.

Bhagwat, a United States Public Health Service officer and Board Certified Clinical Neuropsychologist, also explained that integrating behavioral health care into the Army Medical Home has resulted in substantial changes in the way Army Medicine delivers behavioral health services. By integrating behavioral health professionals ("internal behavioral health consultants," or "IBHCs") and behavioral health Care Facilitators (BHCFs) directly into primary care clinics, IBHCs and BHCFs can work as full-time Army Medical Home team members. They assist the team with early identification of behavioral health needs which has allowed more patients to receive appropriate level treatment in primary care, while continuing to allow those with more significant needs to access specialty behavioral health clinics.

Behavioral health team members integrated in the medical home have increased the quality and availability of behavioral health services to all beneficiaries through our primary care clinics. In addition, more family members are able to receive behavioral health services through the MTF, thereby increasing patient satisfaction. Bhagwat explained "the IBHC is part of an interdisciplinary team in the medical home. When a patient comes to see their PCM for a behavioral health or medical issue, the PCM will start a treatment plan with the patient. The IBHC will work with the PCM and patient to help the patient successfully implement the plan by addressing barriers and providing individualized strategies to attain their goals" In addition, Bhagwat goes on to explain, PCMs can consult with IBHCs for a wide variety of reasons including, chronic pain, diabetes, weight, depression, tobacco cessation, sleep difficulties and other concerns.

Positioning behavioral health care as a routine element of primary medical care reduces the barrier of stigma associated with receiving any form of behavioral health care. Patients can make direct appointments with their Medical Home IBHC, but know that the IBHC will be communicating closely with the patient's PCM. Bhagwat's goals for the future are to continue to grow the program and increase awareness of the program's many benefits. Bhagwat states "the Primary Care Behavioral Health program is a highly beneficial but currently underutilized program in Army Medicine. Our goal is to increase utilization to improve the health of the people we serve."