Integrating Primary Care and Consulting Psychiatry

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About the Access Integrated Primary Care Consulting Psychiatry Toolkit

An ever-increasing number of patients with mental health needs has resulted in primary care being referred to as the de facto mental health system in the United States. In instances where patients are referred elsewhere for mental health treatment, less than one-third of the referrals are actually completed. In addition, the stigma involved with receiving mental health care is a proven barrier to patients seeking care. These issues, combined with lack and cost of transportation, distance from service providers, limited clinic hours, and lack of available appointments or insurance coverage, have resulted in an uptick of primary care clinicians taking on prescribing authority for patients with complex mental health issues.

Increased access to consulting psychiatry allows for potentially better management of patients receiving psychiatric care within the primary care system through a number of mechanisms. It provides more convenient access for patients in an environment that they find familiar and acceptable. It also supports and encourages a collaborative effort between psychiatrists, behavioral health consultants (other mental health providers), and primary care clinicians to provide efficient, whole-person care.

Who should use this toolkit?

This toolkit is intended for clinic directors, managers, primary care, behavioral health consultants, and psychiatrists, and provides a framework for a team approach to addressing patients’ behavioral and mental health needs.

What does the toolkit contain?

The Integrated Primary Care Consulting Psychiatry Toolkit includes a detailed flow diagram showing how the primary care physicians, behavioral health consultant, and consulting psychiatrist work together within a clinic, and the key elements of communication during interactions between these entities.

Development of this toolkit

This toolkit was developed by Elizabeth Zeidler Schreiter, PsyD, Nancy Pandhi, MD PhD, and Meghan Fondow, PhD (all affiliated with Access Community Health Centers and the University of Wisconsin-Madison Department of Family Medicine) and Lauren Fahey (affiliated with the Health Innovation Program and the University of Wisconsin-Madison School of Social Work). Additional support was provided by the University of Wisconsin School of Medicine and Public Health’s Health Innovation Program (HIP), and the Community-Academic Partnerships core of the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR), grant UL1 TR000427 from the Clinical and Translational Science Award (CTSA) program of the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health.


Zeidler Schreiter EA, Pandhi N, Fondow MD, Thomas C, Vonk J, Reardon CL, Serrano N. Consulting psychiatry within an integrated primary care model. J Health Care Poor Underserved. 2013 Nov;24(4):1522-30.

Toolkit Citation

Zeidler Schreiter E, Pandhi N, Fondow M, Fahey L. “Access Community Health Centers (Access) Integrated Primary Care Consulting Psychiatry Toolkit.” Access Community Health Centers and UW Health Innovation Program; 2014. Available at:

Access Integrated Primary Care Consulting Psychiatry Toolkit on AHRQ Innovations Exchange

The Access Integrated Primary Care Consulting Psychiatry Toolkit is included as a Service Delivery Innovation Profile in the Agency for Healthcare Research and Quality’s Health Care Innovations Exchange, a web-based program designed to support health care professionals in sharing and adopting innovations that improve health care quality. View the Access Integrated Primary Care Consulting Psychiatry Toolkit profile by clicking the button below.

About the Developer

Access Community Health Centers (Access) in Madison, WI is one of more than 1,200 Federally Qualified Health Centers nationwide that provide medical, dental, mental heatlh, and other services to low income and medically underserved communities. Federally Qualified Health Centers’ care costs are among the lowest, and their focus on prevention reduces the need for more expensive hospital and specialty care. With multiple locations in the Dane County greater area, Access served over 25,000 residents in the last year, providing affordable services to patients with the fewest resources.