Dennis S. Freeman, PhD
The emerging practice of primary care psychology is creating new opportunities for psychologists. Psychologists are adapting their skills to the primary care environment and primary care providers are welcoming them into their practices and sharing patients with them. The Federally Qualified Health Centers (FQHC) are recruiting behaviorists to their mission of creating health care homes for underserved populations. Graduate schools that offer degrees in psychology are adding courses pertaining to practice in primary care settings and negotiating training rotations to provide this experience for their students. As psychologists enter main stream health care, the profession is poised to make significant contributions to the health status of the nation.
Cherokee Health Systems, a community-based health services organization in Tennessee, has been seeking to blend behavioral health perspectives and services into primary care for nearly three decades. Tracing the evolution of Cherokee Health Systems illuminates some of the factors promoting the emergence of primary care psychology in public sector programs. The reach and proven effectiveness of the care model at Cherokee and other safety net organizations assures that the model will continue to proliferate throughout the public sector.
Rooted in the community mental health ideology of the 1960’s, Cherokee now provides primary care with a Behavioral Health Consultant embedded in the primary care team. The clinical care model combines the skills and energies of mental health and primary care providers, thereby reducing the customary isolation of mental health services and blending behavioral health interventions into the primary care visit. The array of specialty mental health services typical of contemporary Community Mental Health Centers (CMHS) is also available when patients need, and are motivated for, more intensive mental health care. This clinical care model appeals to a wide spectrum of the community, including many patients with commercial insurance who have the freedom to select from a wide range of treatment options. Cherokee provided services to more than 50,000 different area residents over the past year. The clinical staff currently includes 42 primary care providers and 36 psychologists.
At Cherokee Health Systems, Behavioral Health Consultants work as core members of the primary care team, following a flexible schedule similar to that of their primary care colleagues. The Behavioral Health Consultant, generally a psychologist with a behavioral medicine orientation, is available at the time of the primary care visit for assessment, triage and intervention for all those mental health, stress-related, and family problems which flood primary care practices. More than 80% of the mental health problems are managed in primary care without referral to specialty psychiatric services. Often behavioral alternatives to psycho-pharmaceutical interventions are utilized and, when these medications are necessary, behavioral strategies are also employed, which enhance the effectiveness of care.