More than 50 million adults in the U.S. experienced a mental illness between 2019 and 2020—and more than half of them did not receive treatment. Similar numbers are reported for youth. Nearly 60% of individuals with major depression do not receive any mental health treatment (Mental Health America, 2023). Less than one percent of school-aged students receive services under an individualized educational program due to identification with emotional disturbance, despite reported high and rising rates of mental or behavioral health conditions affecting educational performance in this population (U.S. Department of Education, 2023).  

There is no one reason for this lack of care; however, an important consideration is that there are 350 people for every one mental health provider in the U.S.   

Mental illness is associated with increased occurrence of chronic disease, reduced adherence to treatment therapies, higher risks of adverse health outcomes, and burgeoning healthcare costs (Substance Abuse and Mental Health Services Administration, 2020). It stands to reason that medical settings are seeing an increasing number of patients with un- and underdiagnosed mental and behavioral health concerns, whether that is the stated reason for the visit or not. Although the idea of understanding the whole patient, the disease, and the psychosocial characteristics is not a new one (it was a guiding principle of some of the great physicians of the 19th century), the prevalence of psychological conditions within the medical setting creates a dilemma for medical providers. Physicians have very limited time with most patients, and this is often divided between taking a history, reviewing medical test findings, and patient examination, leaving little to no time for exploring psychological variables.  

This is where behavioral health comes in. The behavioral health provider will use clinical assessment tools to evaluate biopsychosocial findings related to physical health or illness/injury/disability; assess these and other behavioral risk factors for the development or worsening of physical illness, injury, or disability; and then design and evaluate empirically based health promotion, prevention, and other interventions that are appropriate for and targeted to the patient.    

Behavioral health providers can help recognize potential mental health, emotional, or behavioral problems before they interfere with a patient’s response to and recovery from treatment and help identify those psychological factors that may be beneficial in supporting a targeted treatment plan or interfere with the patient’s ability to follow a treatment plan.  

Over the last several decades, behavioral healthcare in medical settings has been implemented under several different models, but the overall idea is that be havioral health providers will collaborate with primary care providers to assist with patient care. A patient is referred to behavioral health when either the patient has not been compliant with the medical treatment program or the treatment has not succeeded to the level the doctor had anticipated. Medical providers also will refer patients for mental or behavioral health evaluation when the case is complex and/or mental health comorbidities are present.  

Medical providers and mental/behavioral health providers focus on different aspects of patient care, but working together allows a focus on the whole person, enabling the development of a treatment plan specific to the individual’s needs, including those mental, emotional, and behavioral factors that often impact medical conditions, thereby improving medical care and outcomes.  

Assessing, treating, and—possibly more importantly—monitoring progress of mental or behavioral conditions among those with medical conditions becomes a critical factor in reducing mental or behavioral health conditions and mitigating their negative effects, including effects on medical care.  

It is important to include evidence-based assessment as part of the process of implementing evidence-based practices in clinical settings. Baseline evaluation and ongoing progress monitoring are important components of this process; both are routine in other areas of healthcare. The use of standardized assessment tools to monitor and evaluate treatment and provide feedback over the course of treatment can result in improved outcomes in both youth and adults and increases use of evidence-based practice.  

There are many important considerations when selecting an assessment instrument. Instruments selected should have strong psychometric properties and be appropriate for use in the population for which they are being used. Psychological test validity is very strong and compelling and is comparable to medical test validity. The objective of psychological assessment is to provide useful information regarding the planning, implementation, and evaluation of treatment. The most important factor in test selection is the extent to which the test is useful in answering the referral question.  

Including mental and behavioral health in medical settings helps to ensure an individual’s mental, behavioral, and emotional concerns don’t go unaddressed or untreated, making a successful outcome more likely. It’s incredibly important to continue to pair mental health and physical health needs to better help those we serve. 

References 

Reinert, M., Fritze, D., & Nguyen, T. (October 2022). The state of mental health in America 2023. Mental Health America.  

Substance Abuse and Mental Health Services Administration. (2020). National survey on drug use and health. Center for Behavioral Health Statistics and Quality.  

U.S. Department of Education. (2023). Common core of data. National Center for Education Statistics.