Mental health delivery in primary care: The perspectives of primary care providers

Published:August 19, 2019DOI:


      • The study explored perspectives of PCPs (nurse practitioners and physicians) on mental health care delivery in primary care
      • PCP responses suggested lack of emphasis on mental health in primary care settings
      • PCPs acknowledged importance of mental health care delivery, but cited challenges such as limited time



      To explore perspectives of primary care providers (PCPs), including physicians and nurse practitioners (NPs), about delivery of mental health care in primary care settings.


      We used a qualitative descriptive designed convenience sample of physicians (N = 12) and NPs (N = 14) through face-to-face interviews in New York State.


      Three themes emerged: 1) prioritization of patient needs; 2) applicability of mental health care in primary care settings; and 3) physician and NP approaches to mental health care.


      PCPs recognized importance of addressing patients' mental health care needs and barriers in primary care practices.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Psychiatric Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Agency for Healthcare Research and Quality
        Experts call for integrating mental health into primary care: Research activities.
        in: Retrieved from. 2012
      1. Association of American Medical Colleges.(2016). Physician specialty data report: Number and percentage of active physicians by age and specialty, 2015. Retrieved from

        • Auerbach D.I.
        Will the NP workforce grow in the future?.
        Medical Care. 2012; 50: 606-610
        • Brenner A.M.
        • Balon R.
        • Coverdale J.H.
        • Beresin E.V.
        • Guerrero A.P.S.
        • Louie A.K.
        • Roberts L.W.
        Psychiatry workforce and psychiatry recruitment: Two intertwined challenges.
        Academic Psychiatry. 2017; 41: 202-206
        • Cherry D.K.
        Percentage of mental health-related primary care office visits, by age group-National Ambulatory Medical Care Survey, United States, 2010.
        Moribidity Mortal Weekly Report. 2014; 63: 1118
        • Cooper S.
        • Valleley R.J.
        • Polaha J.
        • Begeny J.
        • Evans J.H.
        Running out of time: Physician management of behavioral health concerns in rural pediatric primary care.
        Pediatrics. 2006; 118: e132-e138
        • Creswell J.W.
        Qualitative inquiry and research design: Choosing among five approaches.
        Sage Publications, Los Angeles,CA2013
      2. Croghan T.W., Brown J.D.(2010) Integrating mental health treatment into the Patient Centered Medical Home (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO2) AHRQ Publication No. 10-0084-EF. Rockville, MD: Agency for Healthcare Research and Quality.

        • Crowley R.A.
        • Kirschner N.
        The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: Executive summary of an american college of physicians position paper.
        Annals of Internal Medicine. 2015; 163: 298
        • Cunningham P.J.
        Beyond parity: Primary care physicians’ perspectives on access to mental health care.
        Health Affairs. 2009; 28: w490-w501
        • De Jacq K.
        • Norful A.A.
        • Larson E.
        The variability of nursing attitudes toward mental illness: An integrative review.
        Archives of Psychiatric Nursing. 2016; 30: 788-796
        • Foo P.K.
        • Frankel R.M.
        • McGuire T.G.
        • Zaslavsky A.M.
        • Lafata J.E.
        • Tai-Seale M.
        Patient and physician race and the allocation of time and patient engagement efforts to mental health discussions in primary care.
        Journal of Ambulatory Care Management. 2017; 40: 246-256
        • Guba E.G.
        Criteria for assessing the trustworthiness of naturalistic inquiries.
        Journal of Education Communication Technology. 1981; 29: 75
        • IBM SPSS Statistics for Windows (Version 24.0)
        NY, IBM Corp2016
        • Kallio H.
        • Pietilä A.-M.
        • Johnson M.
        • Kangasniemi M.
        Systematic methodological review: Developing a framework for a qualitative semi-structured interview guide.
        Journal of Advanced Nursing. 2016; 72: 2954-2965
        • Kuper A.
        • Lingard L.
        • Levinson W.
        Critically appraising qualitative research.
        British Medical Journal. 2008; 337
        • Loeb D.F.
        • Bayliss E.A.
        • Binswanger I.A.
        • Candrian C.
        • deGruy F.V.
        Primary care physician perceptions on caring for complex patients with medical and mental illness.
        Journal of General Internal Medicine. 2012; 27: 945-952
        • Mays N.
        Qualitative research in health care: Assessing quality in qualitative research.
        British Medical Journal. 2000; 320: 50-52
      3. National Committee for Quality Assurance.(2014). Patient-centered medical home. Retrieved from

        • Norful A.A.
        • de Jacq K.
        • Carlino R.
        • Poghosyan L.
        Nurse practitioner–physician comanagement: A theoretical model to alleviate primary care strain.
        The Annals of Family Medicine. 2018; 16: 250-256
        • Norful A.A.
        • Dillon J.C.
        • Ye S.
        • Poghosyan L.
        The perspectives of nurse practitioners and physicians on increasing the number of registered nurses in primary care.
        Nursing Economics. 2018; 36: 182-188
        • Norful A.A.
        • Swords K.
        • Marichal M.
        • Cho H.
        • Poghosyan L.
        Nurse practitioner–physician comanagement of primary care patients.
        Health Care Management Review. 2017; 1
        • NVivo 11 (Version 11)
        QSR International, Australia2014
        • Olfson M.
        • Blanco C.
        • Wang S.
        • Laje G.
        • Correll C.U.
        National trends in the mental health care of children, adolescents, and adults by office-based physicians.
        JAMA Psychiatry. 2014; 71: 81
        • Pahwa R.
        • Chatterjee A.
        • Tallen L.
        • Brekke J.
        Barriers in accessing health care for individuals with severe mental illness: A qualitative study.
        in: Paper presented at: Fourteenth Annual Conference of the Society for Social Work and Research. CA, San Francisco2010
        • Poghosyan L.
        • Nannini A.
        • Smaldone A.
        • Clarke S.
        • O’Rourke N.C.
        • Rosato B.G.
        • Berkowitz B.
        Revisiting scope of practice facilitators and barriers for primary care nurse practitioners.
        Policy, Politics, & Nursing Practice. 2013; 14: 6-15
        • Poghosyan L.
        • Norful A.A.
        • Fleck E.
        • Bruzzese J.-M.
        • Talsma A.
        • Nannini A.
        Primary care providers’ perspectives on errors of omission.
        The Journal of the American Board of Family Medicine. 2017; 30: 733-742
        • Sandelowski M.
        Qualitative analysis: What it is and how to begin.
        Research in Nursing & Health. 1995; 18: 371-375
        • Sandelowski M.
        Sample size in qualitative research.
        Research in Nursing & Health. 1995; 18: 179-183
        • Sandelowski M.
        Whatever happened to qualitative description?.
        Research in Nursing & Health. 2000; 23: 334-340
        • Starfield B.
        • Shi L.
        • Macinko J.
        Contribution of primary care to health systems and health.
        The Milbank Quarterly. 2005; 83: 457-502
      4. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). (2017). Retrieved from

      5. The Joint Commission Accreditation Ambulatory Care. (2011) The joint commission primary care medical home (PCMH) model. Retrieved from

        • Thomas K.
        • Ellis A.
        • Konrad T.
        • Holzer C.
        • Morrissey J.
        County-level estimates of mental health professional shortage in the United States.
        Psychiatric Services. 2009; 60
      6. U.S. Department of Health and Human Services. (2014). HHS awards $54.6 million in affordable care act mental health services funding. Retrieved from

      7. U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Health Workforce National Center for Health Workforce Analysis. (2016). National and regional projections of supply and demand for primary care practitioners: 2013–2025. Retrieved from

        • Xue Y.
        • Ye Z.
        • Brewer C.
        • Spetz J.
        Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.
        Nursing Outlook. 2016; 64: 71-85
        • Yang B.K.
        • Trinkoff A.M.
        • Zito J.M.
        • Burcu M.
        • Safer D.J.
        • Storr C.L.
        • Idzik S.
        Nurse practitioner independent practice authority and mental health service delivery in U.S. community health centers.
        Psychiatric Services. 2017; 68: 1032-1038