Behavioral Health and Primary Care Integration

Learn how HRSA is addressing the opioid crisis.

Primary care providers play a critical role in treating substance use disorders (SUD). They are also on the front line for patients’ behavioral health needs. Integrated behavioral health services can include prevention and safe and effective pain management.

HRSA supports health centers to provide integrated behavioral health services in primary health care through supplemental grant funding, technical assistance (TA), and training. Health Centers provide integrated behavioral health services by: 

  • Increasing access to screening for mental health and substance use disorders.
  • Providing medication-assisted treatment (MAT) services, detoxification, and recovery support.
  • Delivering telehealth services to increase access to care for health center patients.
  • Providing screening, direct services, and referrals in systems of care designed to address behavioral health concerns.

Health Center Behavioral Health Data

According to the 2020 Uniform Data System (UDS) data, health centers:

  • Provided almost 1.25 million patients with Screening, Brief Intervention, and Referral to Treatment (SBIRT) services.
  • Provided nearly 1.7 million SUD patient visits.
  • Conducted over 14 million mental health visits.
  • Approximately 95% of HRSA health centers provide mental health services.

Patients Served at Health Centers

  • Patients receiving SUD services increased by 108% from 141,569 in 2016 to 294,645 in 2020.
  • Since 2016, the percent of patients screened for depression with a documented follow-up plan increased from 60.34% to 64.21%.
  • In 2020, 13.69% of patients with major depression or dysthymia reached remission in 12 months.
  • Mental health patients increased by 40.5% from 2016 (1,788,577) to 2020 (2,512,287).
  • The number of patients receiving MAT increased 366% (from 39,075 in 2016 to 181,896 in 2019).

Behavioral Health Workforce at Health Centers

Health center employees:

  • SUD full-time employees nearly doubled from 2016 (1,163) to 2019 (2,325.29).
  • 8,362 Drug Addiction Treatment Act (DATA)-waivered professionals provided MAT services.

More than 16,811.24 behavioral health FTEs. This includes psychiatrists, psychologists, social workers, and SUD specialists:

  • Psychiatrists: 913.22 FTEs
  • Licensed Clinical Psychologists: 972.15 FTEs
  • Licensed Clinical Social Workers: 4944.73 FTEs
  • Other Licensed Mental Health Providers: 4495.65 FTEs
  • Other Mental Health Staff: 3160.20 FTEs

Explore additional health center data and reporting information.

Integrated Behavioral Health Services Initiatives

Learn about supplemental funding opportunities to support SUD services at HRSA health centers:

From 2017-2018, HRSA sponsored the Opioid Addiction Treatment (OAT) Extension for Community Healthcare Outcomes. This program supported health centers increasing services related to opioid use disorder (OUD). The slides, audio recordings, and transcripts for the training sessions are below.

  • Overview of Opioid Use Disorder (OUD) – July 28, 2017
    Presentation (PDF – 1.63 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 301 KB)
  • Risk Reduction: Overdose Prevention and Management of Misuse/Risky Use of Opioids – April 8, 2018
    Presentation (PDF – 1.65 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 281 KB)
  • Trauma-informed Care and the role of Adverse Childhood Events in Predisposing to SUDs – August 25, 2017
    Presentation (PDF – 822 KB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 199 KB)
  • Introduction to Motivational Interviewing – April 13, 2018
    Presentation (PDF – 1.83 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 293 KB)
  • Evidence-based Screening and Use of SBIRT Techniques – September 22, 2017
    Presentation (PDF – 1.05 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 239 KB)
  • Medication Treatment of OUD, including Use of Evidence–based Treatment Guidelines for OUD – May 25, 2018
    Presentation (PDF – 1.02 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 216 KB)
  • Effective Team-based Care for OUD + Care Coordination and Addressing SDOH – October 27, 2017
    Presentation (PDF – 1.67 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 258 KB)
  • Office-based Management of OUD Part 1: Evaluation and Management of New Patients – June 22, 2018
    Presentation (PDF – 968 KB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 178 KB)
  • Office-based Management of OUD Part 2: Maintenance and Detecting/Dealing with Relapse – December 8, 2017
    Presentation (PDF – 1.51 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 274 KB)
  • Addressing SUD-related Comorbidities, such as Hepatitis, HIV, Depression, Anxiety, and PTSD – December 8, 2017
    Presentation (PDF – 3.07 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 266 KB)
  • Pain Management in People Who Have OUD; Acute vs. Chronic Pain – September 22, 2017
    Presentation (PDF – 1.33 MB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 217 KB)
  • OUD in Special Populations (Adolescents, Pregnancy) – September 9, 2018
    Presentation (PDF – 676 KB) | Audio HRSA BPHC exit disclaimer | Transcript (PDF – 224 KB)

Related Resources

Clinical Quality Improvement

Bureau of Primary Health Care (BPHC) Behavioral Health (BH) Technical Assistance
This resource is designed to meet the specific needs of HRSA health centers and shall focus on both mental health and substance use disorders (referred to jointly as “behavioral health”), with an emphasis on the opioid epidemic.

Substance Use Warmline
This HRSA-supported resource provides clinician-to-clinician consultation by phone or online. Health center staff can get guidance on treating SUD or chronic pain, and behavioral health

National Institute on Drug Abuse (NIDA)
NIDA provides resources based on scientific research to improve SUD prevention and treatment. They also have resources to enhance public awareness.

CDC Guideline for Prescribing Opioids for Chronic Pain
Resources and materials for anyone prescribing opioid pain medication to adults.

Provider Clinical Support Services
This SAMHSA-sponsored service provides training, and tools on opioid treatment. This includes pain management. It also includes access to coaching and mentoring services. They offer buprenorphine waiver training for clinicians (physicians, nurse practitioners, and physician assistants).

Date Last Reviewed:  September 2021