What Does It Take for Primary Care Practices to Truly Deliver Behavioral Health Care?

In what may be the largest state government behavioral health endeavor nationally, New York State (NYS) is more than midway into a federally supported initiative to fully integrate behavioral health care into ambulatory, primary care resident training sites, beginning with selected academic medical centers (AMCs). This is not simply to detect and refer, nor to colocate medical and mental health services under the same roof or down the hall from each other; it is the integration of behavioral health care, starting with adults with depression, into the standard operations of the primary care practice—no different from how these practices serve people with diabetes mellitus, asthma, or cardiovascular diseases. The goal, over time, is statewide dissemination. In this Viewpoint, I describe the circumstances and the interagency partnership that permitted this initiative to be launched (ie, its essential elements, its tough implementation challenges, and what must be done for sustainability).