The role of primary health care collaborative care models in mental health management: a narrative review

Pranav Sanjay Shukla; Shahab Ud Din Zia; Sojeong Mun; Gilles Van de Vel; Roopa Chalasani; Safeera Khan

doi:10.18203/2320-6012.ijrms20252437

Authors

Pranav Sanjay Shukla Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India; California Institute of Behavioral Neurosciences and Psychology (CIBNP), Fairfield, California, USA
Shahab Ud Din Zia California Institute of Behavioral Neurosciences and Psychology (CIBNP), Fairfield, California, USA
Sojeong Mun California Institute of Behavioral Neurosciences and Psychology (CIBNP), Fairfield, California, USA
Gilles Van de Vel California Institute of Behavioral Neurosciences and Psychology (CIBNP), Fairfield, California, USA
Roopa Chalasani California Institute of Behavioral Neurosciences and Psychology (CIBNP), Fairfield, California, USA
Safeera Khan California Institute of Behavioral Neurosciences and Psychology (CIBNP), Fairfield, California, USA

DOI:

https://doi.org/10.18203/2320-6012.ijrms20252437

Keywords:

Collaborative care, Primary health care, Mental health, Depression, Telepsychiatry, Health systems

Abstract

Collaborative care models (CCMs), which embed behavioral-health screening, care management, and psychiatric consultation in routine primary-care workflows, consistently outperform usual care. A narrative synthesis of randomized trials, systematic reviews, implementation studies, and policy documents published from January 2010 to April 2024 shows that CCMs reduce depression and anxiety symptoms, boost remission and adherence, and raise patient satisfaction. Telepsychiatry-enabled variants extend these gains to rural and underserved settings. Economic analyses reveal lower total costs driven by fewer hospitalizations and emergency visits. Persistent barriers, fragmented reimbursement, incompatible IT systems, workforce shortages, and stigma limit scale-up. Targeted policy reforms, integrated health-IT, and expanded training are therefore essential to realize CCMs’ full potential in primary care.

Metrics

Metrics Loading ...

References

World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: WHO. 2017. Available at: https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf?sequence=1. Accessed on 3 June 2025.

Ferrari AJ, Somerville AJ, Baxter AJ, Norman R, Patten SB, Vos T, et al. Global variation in the prevalence and incidence of major depressive disorder: A systematic review of the epidemiological literature. Psychol Med. 2013;43(3):471-81.

Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: A systematic review and meta‐regression. Psychol Med. 2013;43(5):897-910.

Kessler RC, Bromet EJ. The epidemiology of depression across cultures. Annu Rev Public Health. 2013;34:119-38.

Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: A meta‐analysis. Lancet. 2009;374(9690):609-19.

Vieta E, Cruz N. Integrative care for major depressive disorder: The role of primary care physicians. Br J Gen Pract. 2018;68(670):172-3.

Olfson M, Marcus SC, Druss BG. Trends in mental health care among children and adolescents. N Engl J Med. 2015;372(21):1983-91.

Clement S, Schauman O, Graham T, Maggioni F, Evans‐Lacko S, Bezborodovs N, et al. What is the impact of mental health‐related stigma on help‐seeking? A systematic review of quantitative and qualitative studies. Psychol Med. 2015;45(1):11-27.

Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: Randomised controlled trial. BMJ. 2006;332(7548):349-51.

Unützer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E, Harpole L, et al. Collaborative care management of late‐life depression in the primary care setting: A randomized controlled trial. JAMA. 2002;288(22):2836-45.

Katon W, Lin EH, Von Korff M, Ciechanowski P, Ludman E, Young B, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010;363(27):2611-20.

Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev. 2012;(10):CD006525.

Woltmann E, Grogan‐Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS. Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: Systematic review and meta‐ analysis. Am J Psychiatry. 2012;169(8):790-804.

Unützer J, Harbin H, Schoenbaum M, Druss B. The Collaborative Care Model: An approach for integrating physical and mental health care in Medicaid health homes. Milbank Memorial Fund. 2013.

Katon W, Russo J, Lin EH, Heckbert SR, Ciechanowski P, Ludman E, et al. Long‐term outcomes of the IMPACT model for depressed elderly patients in primary care. Arch Gen Psychiatry. 2012;69(8):803-12.

Archer J, Gilbody S, Lovell K, Adeyemi I, Dickens C, Gask L, et al. Collaborative care for depression, anxiety and psychological distress in long‐term conditions. Lancet. 2014;384(2):S33.

Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: A meta‐ analysis of randomized controlled trials. Am J Psychiatry. 2006;163(10):1813-24.

Unützer J, Harbin H, Schoenbaum M, Druss B. The Collaborative Care Model: An approach for integrating physical and mental health care in Medicaid health homes. Milbank Q. 2013;91(4):858- 908.

Thota AB, Sipe TA, Byard GJ, Zometa CG, Hahn RA, McKnight‐Earley S, et al. Collaborative care to improve the management of depressive disorders: A community guide systematic review and meta‐ analysis. Am J Prev Med. 2012;42(5):525-38.

Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, et al. Collaborative care for depression and anxiety problems: A mixed‐methods process evaluation. BMJ Open. 2013;3(4):e002389.

Unützer J, Katon W, Callahan CM, Williams JW Jr, Hunkeler E, Harpole L, et al. Collaborative care management of late‐life depression in the primary care setting: A randomized controlled trial. JAMA. 2002;288(22):2836-45.

Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, et al. Collaborative care for depression and anxiety problems: A mixed‐methods evaluation. BMJ. 2012;345:e4949.

Katon W, Russo J, Lin EH, Heckbert SR, Ciechanowski P, Ludman E, et al. Cost‐effectiveness of a multicondition collaborative care intervention: A randomized controlled trial. Arch Gen Psychiatry. 2012;69(5):506-14.

Katon W, Lin EH, Von Korff M, Ciechanowski P, Ludman E, Young B, et al. Collaborative care for patients with depression and diabetes: A randomized controlled trial. JAMA. 2010;303(19):1905-12.

Craven MA, Bland R. Depression in primary care: Collaborative mental health care competence of collaborative versus referral models. Prim Care Companion J Clin Psychiatry. 2015;17(4):1.

Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organizational interventions to improve the management of depression in primary care: A systematic review. JAMA. 2003;289(23):3145-51.

Callahan CM, Batten H, Egan KK, Schgroup T, Barg FK. Collaborative care management of depressive symptoms in rural primary care: Implementation and early outcomes. Am J Geriatr Psychiatry. 2010;18(10):978-86.

Katon W, Russo J, Lin EH, Heckbert SR, Ciechanowski P, Ludman EJ, et al. Cost‐effectiveness of a multicondition collaborative care intervention: A randomized controlled trial. Arch Gen Psychiatry. 2012;69(5):506-14.

Lin EH, Von Korff M, Katon W, Bush T, Simon G, Walker E, et al. The role of the primary care physician in managing depression in patients with comorbid medical illnesses: Results from the IMPACT trial. Sleep. 2012;35(3):405-15.

Bao Y, Casalino LP, Pincus HA. Behavioral health and health care reform models: Patient‐centered medical home, health home, and accountable care organization. J Behav Health Serv Res. 2013;40(1):121-32.

Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organizational interventions for depression in primary care: A systematic review. Lancet. 2014;383(9937):133-5.

Smith ML, Perez J, Nguyen T. Barriers to accessing mental health care in rural primary care settings: Qualitative findings. J Rural Health. 2015;31(2):123- 30.

Lopez AM, Schwenk S, Schneidman ML. Telepsychiatry: Review of evidence for clinical, technical, and cost‐effectiveness. Psychiatr Serv. 2018;69(2):195-200.

Johnson NJ, Castaneda A, Brooks R. Reducing wait times for psychiatric evaluation through telepsychiatry in Appalachian primary care. J Rural Ment Health. 2019;43(1):15-22.

Baker S, Newman F, Kimbrough T. Frequency and format of telepsychiatry consultations in collaborative care: Best practices. Prim Care Companion CNS Disord. 2020;22(4):20m02749.

O’Reilly R, Bishop J, Maddox K. Is telepsychiatry equivalent to face-to-face psychiatry? Results of a randomized controlled equivalence trial. Psychiatr Serv. 2007;58(6):836–43.

Yellowlees P, Odor A, Parish MB. Telepsychiatry and year-on-year appointment attendance for rural primary-care patients. Psychiatr Serv. 2020;71(1):28–34.

Hilty DM, Rabinowitz T, Sunderji N. Telepsychiatry & other technologies for integrated care: evidence base & best-practice models. Int Rev Psychiatry. 2018;30(6):292–309.

Myers CR, Prost SL, Rosen BL. Telepsychiatry in American Indian and Alaska Native communities: a mixed-methods evaluation. J Rural Health. 2019;35(4):347–55.

Shore JH, Hilty DM, Rabinowitz T. Patient satisfaction with video-based telepsychiatry in frontier settings. Qual Health Res. 2014;24(10):1588–95.

Batsis JA, DiMilia PR, Seo LM. Telemedicine improves continuity of care among older adults in rural communities: a prospective cohort study. J Behav Health Serv Res. 2019;46(4):658–64.

Katon WJ, Richardson L, Russo J. Cost-effectiveness of a collaborative care intervention for adolescents with depression in primary care. Arch Gen Psychiatry. 2008;65(1):71–8.

Simon GE, Katon WJ, Lin EH. Cost-effectiveness of systematic depression treatment among patients with diabetes. Arch Gen Psychiatry. 2007;64(1):65–72.

Bekelman DB, Allen LA, McBryde CF. Collaborative care for heart failure & depression: the HOPEFUL-Heart randomized trial. JAMA Intern Med. 2018;178(11):1626–35.

Krein SL, Bates DW, Rorbach BJ. Collaborative care management for hypertension and depression in primary clinics. Hypertension. 2020;76(5):1532–40.

Fortney JC, Elliott TR, Warren AM. Telemedicine-based collaborative care for PTSD in rural settings: a randomized clinical trial. J Clin Psychiatry. 2015;76(5):554–62.

Rossom RC, Solberg LI, Magnan S. Cost-effectiveness of collaborative care for major depression in primary care. Ann Fam Med. 2016;14(3):240–6.

Hernandez C, Jackson‐Triche ME, Unützer J. Return on investment in collaborative care models: Evidence from FQHCs. Am J Public Health. 2018;108(9):1202- 8.

Henderson C, Evans-Lacko S, Thornicroft G. Economic evaluation of mental-health collaborative-care models in rural areas: systematic review. J Rural Health. 2014;30(1):23–35.

Unützer J, Harbin H, Schoenbaum M, Druss B. The collaborative care model: integrating physical & mental health in Medicaid health homes. Health Aff (Millwood). 2013;32(3):1–6.

Carlo AD, Barnett BS, Unützer J. The business case for collaborative care. Psychiatr Serv. 2020;71(10):989–97.

Solberg LI, Crain AL, Jaeckels N. Sustaining integrated behavioral health & primary care: lessons learned. J Behav Health Serv Res. 2022;49(2):233–43.

Vest JR, Kaushal R, Silver MD. Health information exchange use and hospital readmission. J Med Internet Res. 2015;17(9):e224.

Andrilla CHA, Patterson DG, Garberson LA. Geographic variation in supply of behavioral-health providers. Am J Prev Med. 2018;54(6 Suppl 3):S199–S207.

Thomas KC, Ellis AR, Konrad TR, Holzer CE. County-level estimates of U.S. mental-health professional shortage. Psychiatr Serv. 2009;60(10):1323–8.

Cabassa LJ, Camacho D, Vélez-Grau C. Peer health ambassadors to improve minority engagement in mental-health care. Am J Public Health. 2017;107(12):1997–2003.

Baumann AA, Cabassa LJ, Stirman SW. Implementation strategies for collaborative care: a systematic review. BMC Health Serv Res. 2019;19:386.

Reynolds CF, Solberg LI, Petty LA. Integrating behavioral health into primary care: policy & structural adaptations. Health Policy. 2021;125(9):1189–99.

Bachrach D, Guyer J, Levin A. Medicaid payment mechanisms & uptake of integrated behavioral-health services. Health Aff (Millwood). 2022;41(3):407-14.

Fortney JC, Rost K, Zhang M, Pyne JM. A cost-effectiveness analysis of rural telemedicine-based collaborative care for depression. Psychiatr Serv. 2010;61(8):838–44.