Collaborative Care Models in Mental Health

Evidence Supporting Collaboration

The American College of Physicians explicitly endorses collaborative team models that include physicians and advanced practice registered nurses working together to address healthcare needs, particularly in areas with provider shortages 1, 2
Nurse practitioners are critical to improving access to mental health care, especially in underserved communities where traditional psychiatric services may be limited 1, 2
Collaborative teams of physicians and nonphysicians are necessary to provide quality care for individuals with both common and complex health care needs 1, 2
Most state laws do not require physical proximity between supervising/collaborating physicians and NPs, allowing for flexible collaborative arrangements 1, 2

Family physicians benefit significantly from having access to ongoing consultation with mental health specialists, which increases provider comfort with diagnosing and treating mental health issues 3
Access to consultation is crucial, with more than 25 states establishing programs promoting collaboration between primary care providers and psychiatrists, offering real-time telephone consultation and referral options 3, 4
Cross-discipline training is needed to prepare behavioral health and primary care physicians to effectively integrate their respective specialties, with strategies including participation in child psychiatry consultation networks and collaborative office rounds 3, 5

The specific legal requirements for collaborative agreements vary by state, and it is essential to verify the state's nurse practice act requirements for collaborative agreements 3
Whether psychiatric NPs require physician collaboration or have full practice authority in the state should be determined, as well as specific documentation and oversight requirements if collaboration is mandated 3, 4

Assuming collaboration means direct supervision, as effective teams recognize that collaboration involves mutual consultation and shared decision-making, not hierarchical control 1, 2
Not leveraging consultation resources, such as free psychiatric consultation programs that can support both the family physician and psychiatric NP 3

Collaborative care models that incorporate behavioral health providers as core members of primary care teams have shown significant benefits, with a 2012 Cochrane Collaborative review demonstrating significantly greater improvement in anxiety and depression outcomes for adults treated under a collaborative model of care than those treated by traditional means 6, 7, 8
The collaborative care model has shown effectiveness for depression, anxiety, at-risk alcohol use, and attention deficit-hyperactivity disorder in primary care settings, with medical use decreasing by an average of 15.7% for patients receiving behavioral health treatment 9

Cross-discipline training is needed to prepare behavioral health and primary care physicians to effectively integrate their respective specialties 10

The American College of Physicians supports increased research to define the most effective and efficient approaches to integrate behavioral health care in the primary care setting 11