Partnering for Whole-Person Care: A Primary Care Physician’s Experience With the Northwestern Medicine Collaborative Behavioral Health Program
For Christine Amstadt, DO, a primary care physician and champion of the Collaborative Behavioral Health Program (CBHP) at Northwestern Medicine, mental health is an integral part of primary care.
“At least half of the patients I see have mental health issues to varying degrees,” she says. “You can’t have whole-person care without addressing mental health. Sometimes, mental health is the only issue they come in for, but usually, they come in for another reason, and mental health concerns come up in our discussions.”
Dr. Amstadt notes that supporting patients’ mental health isn’t just compassionate care — it’s essential for improving health outcomes.
“We know from multiple studies that patients with chronic diseases like diabetes and hypertension have poorer health outcomes when their mental health needs aren’t met,” she says. “Improving access to mental health care is essential for patients to achieve their health goals.”
Addressing barriers to behavioral health access
As a primary care physician, Dr. Amstadt says her biggest challenge is connecting patients with timely mental health care.
“There aren’t enough mental health providers to meet the needs of all patients who need them,” she says. “We have to look for an alternative way to meet their needs other than one-on-one psychiatry care. In addition, CBHP allows for access to mental health services for all Northwestern Medicine patients regardless of insurance type — this is often a significant barrier for patients.”
Collaborative care support
That’s where the CBHP comes in. The program integrates behavioral health coordinators into primary care settings, enabling physicians like Dr. Amstadt to extend mental health support to more patients.
“I know I’m not going to get all the patients who need it in to see a psychiatrist,” she says. “CBHP allows me to see patients with mild-to-moderate depression and anxiety. I can take care of more patients with these issues knowing I have the support of behavioral health specialists who are keeping an eye on patients in between visits, making sure patients are adhering to their treatment plan and, if not, how we can change it. We have psychiatric consultants who provide input to see if there are improvements we can make in medication management to help patients achieve their best mental health. As primary care physicians, we are already caring for these patients. CBHP enhances this care and allows us to increase the number and complexity of patients with mental health needs.”
Learning the collaborative care model
When she first began using the CBHP, Dr. Amstadt found the workflow shift challenging. But once she made her first referral, the benefits quickly became clear.
“Much of the initial shift was understanding the basis of collaborative care,” she says. “It’s a team-based approach to taking care of my patients. I’m still the one responsible for prescribing medications, and the patient and I are making the final decision on their treatment plan, but I have other resources to help us get them to achieve the best mental and physical health. That shift from the traditional referral model to understanding how collaborative care can help my patients and me was a big part of how I was able to incorporate it into practice.”
Dr. Amstadt notes that referring patients created a positive feedback loop.
“The more I referred patients, the more I saw them improve, in a much faster timeframe than I would be able to achieve on my own,” she says.
Dr. Amstadt also credits the Grand Rounds and training sessions at Northwestern Medicine for helping her integrate CBHP into her daily workflow.
Incorporating behavioral health into everyday practice
In the past six months, Dr. Amstadt has fully integrated the program into her routine care. She screens every patient for depression at their annual wellness exam and now looks for more opportunities to screen throughout the year.
“I look at my patient list for the day and am more proactive about considering who needs to be screened,” she says.
The change has been transformative.
“My patient visits have changed because I now have tools,” she says. “Before CBHP, it was frustrating. If a patient expressed mental health concerns, I never knew if I’d be able to refer them to a counselor or psychiatrist and be confident that they would actually get in to see someone. That sense of confidence that I have something to offer my patients has changed my approach.”
Positive results and patient impact
Even referred patients who don’t qualify for the CBHP still benefit from the program’s resources.
“If I refer a patient to CBHP and they don’t qualify for the program, they still leave with a set of resources from the behavioral health coordinator,” she says. “That’s a tremendous help to me.”
Several of Dr. Amstadt’s patients have completed CBHP and seen measurable improvements.
“I love that I can see their PHQ-9 or GAD-7 scores change as they complete the program,” she says. “I love to see that they feel more confident, have more self-advocacy and just feel better. I also have a resource if their symptoms worsen in the future — we have somewhere to turn. That’s been invaluable.”
One patient recently told Dr. Amstadt that meeting with a behavioral health coordinator gave her something she hadn’t felt in a long time: hope.
“That had a big impact on me,” says Dr. Amstadt. “There’s a lot of relief in that as a primary care physician.”
For Dr. Amstadt, collaborative care has not only enhanced her ability to support patients’ mental health, but it’s also renewed her own sense of purpose as a primary care physician. The CBHP model, she says, gives clinicians the structure and support to deliver true whole-person care.
Learn more about the Collaborative Behavioral Health Program at Northwestern Medicine.