The Conversation

We'd love to hear the story behind the Integrated Behavioral Health (IBH) Program.

The roots of our IBH program began with a pilot in one of our employer-based primary care clinics, designed to address several pressing patient needs. Patients were experiencing significant barriers to accessing psychiatry services, and referrals often weren’t leading to timely care.  

So we piloted a collaborative care model that embedded social workers into a primary care clinic with support from a consulting psychiatrist. That early work significantly improved access and reduced reliance on traditional psychiatry referrals. It quickly became clear that primary care clinicians (PCPs) across other settings were looking for similar support.  

Around the same time, new clinical guidelines around suicide risk screening reinforced the importance of building systems that readily identified patients at risk and ensure we could respond appropriately and consistently when concerns were identified. 

As interest grew, we expanded the model into our faculty clinics, beginning with psychiatry eConsults and gradually building toward co-visits and more integrated team-based workflows. Over time, we grew our social work team so that behavioral health support could be more fully aligned with primary care needs. More recently, our team partnered to help develop an IBH model in our affiliated community clinic network, Stanford Medicine Partners.

Together, these efforts shaped the development of a more comprehensive integrated behavioral health model supported by close partnership across primary care, psychiatry, social work, and ambulatory operations leadership.  

Your research shows that 70% of primary care visits are driven by behavioral or psychological concerns, with PCPs writing nearly four out of five antidepressant prescriptions and caring for 60% of individuals treated for depression. How does your integrated model support these physicians? 

One of the most immediate benefits is timely access to psychiatric expertise through multiple consultation pathways built directly into primary care workflows. PCPs can collaborate with our IBH consulting psychiatrists through eConsults, co-visits, and curbside consultations by pager or text when urgent clinical questions arise. We also have an IBH PCP Champion who helps bridge primary care, social work, and psychiatry by providing time-limited consultation and medication management.

Because the psychiatrists and IBH PCP Champion know us, our work, and our patients, they encourage us to reach out. Having that kind of real-time access is incredibly valuable and allows PCPs to make informed treatment decisions much more quickly than would be possible through traditional referral pathways alone. 

Our embedded social work team also plays a central role by providing short-term therapy and behavioral health support within primary care, helping patients receive evidence-based care without long waits or the need to navigate insurance barriers or external systems. 

This partnership helps create a system where patients receive more timely, coordinated, and whole-person care — and where PCPs feel supported rather than isolated in managing behavioral health concerns.

Mental health needs can get missed in short, 15-30 minute appointments.  What key aspects of the IBH model help PCPs identify these needs, and how does it differ from non-integrated primary care clinics?

I love this question because it highlights how closely our depression and anxiety screening program is connected to our clinical IBH model. 

We have depression and anxiety screening questionnaires automatically sent to patients to fill out before an upcoming visit, in their own time and space. Providers receive a notification if a patient has a high score, allowing them to prepare ahead of time and respond thoughtfully during the visit. 

In clinics without an IBH model, screening can feel much more burdensome because the responsibility for follow-up of screening results falls largely on the PCP alone. Access to mental health care is generally limited and when patients are referred to mental health care in the community, PCPs often have limited visibility into whether patients were able to connect with services, what evaluation was completed, and what treatment plan was recommended. That makes coordinated care much more difficult. 

By contrast, our IBH model creates a shared system of screening, consultation, and short-term treatment support within primary care, allowing clinicians to identify needs earlier and respond as part of a coordinated care team. 

You treat patients who may have both physical and mental health needs. Could you walk me through what that looks like for the IBH provider AND the patient? 

It’s very common for physical and mental health conditions to affect each other. 

From a provider perspective, we see every day how untreated depression and anxiety can make it harder for patients to manage chronic medical conditions like diabetes. Symptoms such as fatigue, poor concentration, disrupted sleep, and low motivation directly affect a patient’s ability to follow treatment plans and engage in their care. 

The IBH model allows us to address both at the same time. If a patient screens positive for depression or anxiety during a visit for a medical concern, we can initiate treatment in primary care. This collaboration goes both directions. Our social workers and  IBH- consulting psychiatrists help identify when physical symptoms may be contributing to mental health concerns (and vice versa), collaborating  with PCPs and specialists to address these issues in treatment plans.  

From the patient perspective, many feel relieved mental health is part of the conversation. They appreciate their care team is incorporating behavioral health into their overall care plan rather than treating it as something separate. 

Are there particular patient stories that resonate with you—moments that made you think, 'This is exactly why we created this program'? 

Two patients immediately come to mind: 

One is a patient with emerging symptoms of obsessive-compulsive disorder (OCD). OCD is not something most PCPs manage frequently, but through an IBH psychiatry eConsult, I was able to confirm the diagnosis quickly and develop a treatment plan. We started medication and connected the patient with appropriate resources, and within a few months they reported feeling better than they had in years. Without IBH, that patient likely would have waited months to see psychiatry while their symptoms worsened. 

Another experience involved a patient with decompensated paranoid schizophrenia who had lost access to their psychiatrist and long-acting injectable medication. This led to worsening of their schizophrenia, which ultimately resulted in housing instability and further psychiatric distress and medical decompensation. They began visiting the emergency department almost weekly for over a year. 

After working closely with our IBH psychiatry partners, complex care management program and our ambulatory operations team, we were able to restart long-acting antipsychotic medication treatment in primary care under specialist guidance. Over a short time, the patient stabilized, their emergency department visits dropped significantly, and they were able to maintain stable temporary housing. I still remember the visit when they told me they no longer felt angry all the time. 

I also think about the cases when I’ve seen patients who have acute or urgent symptoms of a mental health crisis and I was able to quickly connect with social work or psychiatry for advice and support. There are also numerous examples of patients with longstanding mental health conditions who were previously unable to access care due to insurance barriers. Because our IBH team is integrated into primary care, insurance is not a barrier to access our program.  

 Most of us know that sleep, diet, and exercise are important. Beyond those big three, what is one of the most powerful, yet often overlooked, things people can do to actively support their mental health?

One of the most powerful — and often overlooked — supports for mental health is social connection. Maintaining relationships with friends, family, neighbors, or community groups helps buffer stress and improves resilience over time. Even small, consistent points of connection can make a meaningful difference.

Most of us know that sleep, diet, and exercise are important. Beyond those big three, what is one of the most powerful, yet often overlooked, things people can do to actively support their mental health?

One of the most powerful — and often overlooked — supports for mental health is social connection. Maintaining relationships with friends, family, neighbors, or community groups helps buffer stress and improves resilience over time. Even small, consistent points of connection can make a meaningful difference.  

Acknowledgements

The success and growth of the Integrated Behavioral Health (IBH) Program reflects a strong interdisciplinary collaboration across primary care, psychiatry, social work, and Stanford Health Care ambulatory operations. Central to the program’s development and expansion has been the close partnership of Psychiatry Program Director Mira Zein, MD; Social Work Manager Camille Bekkers, LCSW; and Ambulatory Operations Manager Julie Varvel, MHA, MT.

The program also recognizes the contributions of IBH social workers Amy Mann, Sarah Martinez, Terry Podesta, Thao Truong, and Christiana Weidanz; IBH PCP Champion Eric Crizer, MSN, RN, FNP; Psychiatry Director of Education Matt Gunther, MD, MA; and Psychiatry eConsultant Andrea Ament, MD, whose work supporting patients and partnering with primary care teams helps bring the IBH model to life each day.

Additional acknowledgment goes to health system sponsors and leaders Tim Morrison, EdD, LCSW; Heather Filipowicz, MS, RD; Sang Chang, MD; and Jose Maldonado, MD, whose leadership, vision, and support have been instrumental in establishing IBH as a key priority across primary care.