The landscape of mental health care in the United States is evolving rapidly, and primary care mental health is becoming increasingly central to overall patient care. A recent study published in Health Affairs reveals that the percentage of primary care visits addressing mental health concerns rose from 10.7% in 2006 and 2007 to 15.9% by 2016 and 2018.
Researchers analyzed a sample of 109,890 primary care visits spanning 2006 to 2018, highlighting a steady increase in the attention given to behavioral health in primary care. This trend is particularly significant given the growing prevalence of mental health conditions in the population and the ongoing shortage of specialized mental health providers.
“One in four U.S. adults had an anxiety or depressive disorder in 2021. And there’s a shortage of psychiatrists,” said Dr. Lisa Rotenstein, co-author of the study. “So in that context, we found that the proportion of primary care visits addressing mental health concerns increased almost 50% from 2006 to 2018.”
In addition to co-leading the study, Rotenstein serves as the medical director of population health at Brigham and Women’s Hospital’s Primary Care Center of Excellence, giving her a unique perspective on how primary care mental health is integrated into regular patient care.
Why Primary Care Is a Key Entry Point
Primary care is often the first point of contact for individuals experiencing mental health concerns. Many people may not initially seek specialized psychiatric care due to stigma, access challenges, or cost. Primary care mental health services therefore act as a critical entry point for patients, allowing them to receive timely support for anxiety, depression, and other common behavioral health concerns.
“Primary care providers are a great starting point for addressing mental health concerns,” Rotenstein explained. “They’re comfortable treating anxiety, depressive symptoms, and similar conditions. But delivering effective mental health care often requires a multidisciplinary approach, adequate time, and coordination with specialists.”
Anxiety and Stress Are Most Commonly Addressed
The Health Affairs study found that anxiety and stress were the mental health conditions most frequently addressed in primary care visits, with significant increases over time.
- In 2006 and 2007, 29.9% of mental health visits in primary care addressed anxiety.
- By 2014–2015, that number had risen to 38%.
- In 2016–2018, anxiety remained a focus in 34.5% of mental health visits.
Depression was also commonly addressed, reflecting the prevalence of these conditions in the general population. Meanwhile, serious mental illness—such as schizophrenia or bipolar disorder—remained the least addressed in primary care, demonstrating the limits of primary care mental health alone in managing complex psychiatric conditions.
This data reinforces that primary care mental health is well-suited for certain diagnoses, but more complex cases require collaborative, team-based care.
Continuity Matters: Seeing Your Regular Doctor Makes a Difference
Another key finding of the study is that patients were more likely to discuss mental health concerns with their regular primary care physician than with another doctor.
“Having a consistent provider helps patients feel more comfortable discussing sensitive issues, and it allows for better follow-up and care coordination,” Rotenstein said.
Longitudinal relationships with primary care providers improve trust, continuity of care, and the likelihood that mental health concerns will be raised and addressed—further emphasizing the importance of mental health care in building ongoing, effective care.
Disparities in Primary Care Mental Health
While the increase in mental health discussions in primary care is encouraging, the study revealed significant disparities in who receives care:
- Black patients were 40% less likely than white patients to have a mental health concern addressed during a primary care visit.
- Hispanic patients were 40% less likely than non-Hispanic patients to have behavioral health concerns addressed.
“These disparities suggest that there are barriers even within primary care,” Rotenstein noted. “To effectively meet population needs, we need to better understand what is preventing Black and Hispanic patients from having mental health concerns addressed as frequently. Are they being screened less often? Are cultural or language barriers at play?”
Addressing these disparities is critical to ensuring equitable access to primary care mental health services for all patients.
Collaborative Care: The Future of Primary Care Mental Health
The study emphasizes that collaborative care models are essential to support primary care providers in meeting the growing demand for mental health services. Collaborative care integrates primary care physicians, behavioral health specialists, and care coordinators into a single, coordinated approach to care.
Rotenstein outlined several strategies to support PCPs in delivering effective mental health care:
- Co-located therapy or psychiatry: Embedding mental health professionals within primary care clinics.
- eConsult services: Allowing psychiatrists to advise PCPs on complex cases remotely.
- Longer visit times: Giving PCPs adequate time to address mental health alongside physical health concerns.
- Team-based support: Including care managers and behavioral health coordinators to help manage patient follow-up and monitoring.
Such models not only improve patient outcomes but also reduce burnout among primary care providers, who are increasingly responsible for addressing mental health needs.
Implications for Policy and Reimbursement
To fully support primary care mental health, reimbursement systems must reflect the time and resources required to provide effective care. Current payment models often prioritize high patient throughput, leaving little time for in-depth mental health discussions.
Investing in primary care mental health—through adequate reimbursement, staffing support, and training—can lead to better outcomes, reduced hospitalizations, and improved patient satisfaction. Policies that incentivize integrated care and collaborative models can help primary care meet the mental health needs of the population.
Conclusion
The role of mental health care is expanding, reflecting both rising demand and systemic necessity. Anxiety and depression are increasingly addressed in primary care visits, and the continuity of care provided by regular PCPs is a crucial factor in effective mental health management.
However, challenges remain: serious mental illness is under-addressed, and disparities persist for Black and Hispanic patients. The study underscores the importance of collaborative care, adequate resources, and equitable access.
As primary care continues to evolve, it is becoming not just a first stop for mental health care but a cornerstone of a more integrated, accessible, and patient-centered behavioral health system. With the right policies, training, and team-based approaches, mental health care can help close gaps in mental health care and ensure that all patients receive the support they need.
