The Art of Quietly Making Noise: Orchestrating the Integration of Behavioral Healthcare Into a Multispecialty Medical Group

The ability of medical providers to address emotional distress, psychosocial problems, and mental disorders in a cost-effective way has become increasingly important in recent years. Collaboration between medical and mental health providers in the primary care setting is evolving as one powerful tool to accomplish this goal. The following article describes the personal experience of a collaborative care team during the first stage of integrating behavioral health services into a large, independent, multispecialty medical group. The rationale for providing integrated, collaborative care is briefly reviewed followed by a description of the Nalle Clinic and a review of our vision for a Center for Behavioral Health. An exploration of the various barriers to integration that were encountered during the planning and developmental phases, as well as principles for overcoming these barriers, is provided. Our first person account of "critical events" throughout this process attempts to capture the essential ingredients necessary for successfully integrating behavioral health services.