Primary care - mental health collaboration: an example of assessing usual practice and potential barriers

Practice guidelines include recommendations for collaboration between primary care (PC) and mental health (MH) to improve the quality of depression management within primary care. There is little research, however, assessing usual care relationships between PC and MH providers, or providers' perceptions regarding collaboration. Based on the literature, we conceptualize a continuum of collaborative activities and strategies. We describe the extent of collaboration and perceived barriers in selected outpatient clinics. We conducted semi-structured interviews with 22 PC and MH clinical leaders from 10 outpatient facilities. Topics included existing referral, consultation, and collaboration practices between PC and MH, beliefs and barriers related to collaboration. Informants generally described good relationships between providers, and PC providers reported satisfaction with referrals to MH. Informal consultation also occurred, although it was not universal. There was little evidence of collaboration beyond this basic level. The leaders identified several potential barriers to collaboration, including inadequate staffing and resources for both services. In contrast with practice guidelines, the clinics we studied incorporated little collaboration with MH providers into PC management of depression. We identify strategies that can help overcome the barriers to collaboration that our informants most commonly identified.