Barriers to mental health treatment affect millions in need of care; however, one groundbreaking program recently launched by the UAB Department of Psychiatry and Behavioral Neurobiology is effectively changing that.

Imagine: you’ve been feeling anxious and depressed, so you schedule a visit with your primary care provider. Whereas previously this may have been your first stop in a lengthy line of referrals to specialists to address your mental health needs, now it is your only stop.

That’s because UAB’s Integrated Behavioral Medicine Service (iBeMS) aims to meet your needs for mental health care directly from the office of your primary care provider.

Targeted prevention and early intervention

In essence, UAB’s iBeMS initiative merges psychological care with traditional medical services.

Rather than primary care doctors simply referring patients to psychologists and leaving it up to them to follow through, the program offers psychologists on-site at primary health care facilities –giving patients the opportunity to see them at the same time as their primary care visits.

Under the leadership of Christina Pierpaoli-Parker, Ph.D., director of UAB iBeMS, this model has been implemented in UAB Gardendale Primary Care and Specialty Clinics, UAB Nephrology, and, most recently, UAB Camellia Medical Group, marking a significant milestone in patient-centered health care.

The core objective of iBeMS is to establish an innovative approach to psychological care – one that is both effective and time-limited, integrated into the very fabric of where patients receive their medical treatment.

“Targeting prevention and early intervention, iBeMS uses a collaborative care model to provide brief, stepped care to patients with mild to moderate psychiatric symptoms contributing to chronic health conditions,” Pierpaoli-Parker said. “We provide same-day service to patients who may be experiencing common psychiatric symptoms, including anxiety, depression, and insomnia. We’ve found this diverts referrals out of primary care, increases access to both primary and psychiatric care, and improves patient health outcomes.”

The integration of mental health and physical health

The program's success has already been evident, with preliminary analyses showcasing improved patient-reported outcomes for emotional health symptoms and tangible enhancements in physical health symptoms.

Pierpaoli-Parker noted that only 25 percent of patients who are referred to outpatient mental health facilities by their primary care providers will establish care. However, there is a dramatic shift in acceptance of care numbers when mental health is integrated into the primary care setting, with approximately 90 percent of referred patients receiving and engaging in mental health care.

“Also, medical conditions contain significant psychological comorbidities,” Pierpaoli-Parker said. “Behavior undergirds every facet of the health process, from disease onset to rehabilitation. And, the problem actually lives in primary care. Primary care has been dubbed the de facto mental health system in the United States since the 1970s because most patients will seek mental health services there, not from a mental health provider, largely because of inaccessibility.”

She pointed out that only about 50 percent of patients with a mental disorder are correctly identified in primary care.

“Integrating behavioral health into medical settings democratizes access to evidence-based mental health treatment and also normalizes behavioral health as a part of physical health,” she said. “And in many cases, helps to ease the burden of existing medical conditions.”

Promising results encourage continued development of iBeMS

Research on results is ongoing, but the approach overall is proving to be quite successful.

“Our preliminary findings reveal that a brief course of six to eight visits of iBeMS treatment is associated with rapid, durable, and clinically significant changes in anxiety and depressive symptoms,” Pierpaoli-Parker said.

Additional inquiry continues to explore the contributions of these interventions to improved physical health outcomes as well as decreased health care costs.

“We have strong reason to believe based on robust, existing research that integrated care can reduce health care costs, improve patient health outcomes, and increase access to primary psychiatric care – because it goes for the jugular of most healthcare challenges: mental health,” Pierpaoli-Parker added.

Kristine Lokken, Ph.D., chief psychologist in the UAB Department of Psychiatry and Behavioral Neurobiology, touted several individuals as having been “champions” of iBeMs, including Adrienne Lahti, M.D., department chair, Rachel Fargason, M.D., Matthew Macaluso, D.O., Irf Asif, M.D., Stuart Cohen, M.D., Thalia Baker, Patricia Pritchett, and clinic directors Guarav Jain, M.D., Sarah Cribbs, M.D., and Jay Whatley, M.D.

“We are setting the foundation to truly transform mental health care by providing co-located psychology services where and when patients need them,” Lokken said. This work has enhanced patient care and reduced provider burden."

Here are 5 ways iBeMS is transforming patient care at UAB.

Patient preference and accessibility

UAB’s Integrated Behavioral Medicine Service responds to patient preferences, offering mental health services within primary care settings, maximizing convenience, access, and engagement.

Enhanced diagnostic accuracy

Collaborative care with psychologists clarifies diagnostic processes, preventing the oversight or misattribution of behavioral health concerns.

Improved access and connection

Integrated care minimizes the risk of patients getting lost in the referral process, ensuring that up to 90 percent of individuals receive the care they need.

Comprehensive collaborative care

Providers share diagnostic insights, collaborate on treatment plans, and monitor patient health effectively, leading to more comprehensive care.

Normalization of behavioral health

UAB’s Integrated Behavioral Medicine Service fosters an environment where behavioral health is integral to general medical care, reducing stigma and normalizing mental health treatment.