Evaluating the Effectiveness of Integrated Mental Health and Substance Abuse Services in Primary Care Settings in Ohio, USA

The growing overlap between mental health disorders and substance use conditions has led to increased adoption of integrated behavioral health models within primary care settings. This study evaluates the effectiveness of integrated mental health and substance abuse services in primary care clinics across Ohio, USA, using exclusively electronic health record (EHR) data for assessment. To achieve the aim of this study, two research questions guided the study, corresponding to two research hypotheses. The study employed a retrospective cohort design to analyze EHR-derived measures including diagnostic patterns, treatment engagement, care coordination indicators, medication adherence, and clinical outcomes such as symptom improvement and reduced acute care utilization. The study population included all the 869 adult patients receiving integrated behavioral health services between January, 2023 to December 2024 in five primary health clinics in Ohio. Data obtained from the electronic health record (EHR) were analyzed using one-way analysis of variance (ANOVA) and Hierarchical Regression Analysis. Findings from the analysis of data reveal that, integration significantly improved depression, anxiety, and substance use outcomes over 12 months, reduced emergency department visits, and increased patient satisfaction. Based on these findings, it was recommended that, government should expand training and recruitment of behavioral health professionals in primary care settings to ensure adequate staffing for integrated services. Also, there should be investment in interoperable electronic health records and telehealth platforms to facilitate coordination between primary care providers and behavioral health specialists.

Integrated Care, Mental Health, Substance Use Disorder, Primary Care

1. Agency for Healthcare Research and Quality. (2024). Strategies for integrating behavioral health and primary care: Protocol for a systematic review. https://effectivehealthcare.ahrq.gov/sites/default/ files/product/pdf/strategies-integrating-behavioral-health-protocol.pdf [Google Scholar] [Crossref]

2. Ancker, J. S., Edwards, A., Nosal, S., Hauser, D., Mauer, E., & Kaushal, R. (2017). Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. BMC Medical Informatics and Decision Making, 17(1), 36. https://doi.org/10.1186/s12911-017-0430-8 [Google Scholar] [Crossref]

3. Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., Dickens, C., & Coventry, P. (2012). Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews, (10), Article CD006525. https://doi.org/10.1002/14651858.CD006525.pub2 [Google Scholar] [Crossref]

4. Butler, M., Kane, R. L., McAlpine, D., Kathol, R. G., Fu, S. S., Hagedorn, H., & Wilt, T. J. (2008). Integration of mental health/substance abuse and primary care. (Evidence Report/Technology Assessment No. 173). Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK76532/ [Google Scholar] [Crossref]

5. Conteh, N. K., Latona, A., & Mahomed, O. (2023). Mapping the effectiveness of integrating mental health in HIV programs: A scoping review. BMC Health Services Research, 23, 396. https://doi.org/10.1186/s12913-023-09359-x [Google Scholar] [Crossref]

6. Fields, A. M., Thompson, C. M., Schneider, K. M., Perez, L. M., Reaves, K., Linich, K., & Limberg, D. (2023). The state of integrated primary and behavioral health care research in counselor education: A review of counseling journals. The Professional Counselor, 13(3), 206–221. [Google Scholar] [Crossref]

7. Hawrilenko, M., et al. (2025). Return on Investment of Enhanced Behavioral Health Services. JAMA Network Open. (Published online) [Google Scholar] [Crossref]

8. Institute for Clinical and Economic Review. (2015). Integrating behavioral health into primary care: Defining the research agenda for co-located and integrated services (White paper). [Google Scholar] [Crossref]

9. Isaacs, A. N., & Mitchell, E. K. L. (2024). Mental health integrated care models in primary care and factors that contribute to their effective implementation: A scoping review. International Journal of Mental Health Systems, 18(1), Article 5. https://doi.org/10.1186/s13033-024-00625-x [Google Scholar] [Crossref]

10. Kawamoto, K., McDonald, C. J., Lobach, D. F., & Wright, A. (2021). Clinical decision support for preventive care: A systematic review. Journal of the American Medical Informatics Association, 28(6), 1250–1258. https://doi.org/10.1093/jamia/ocab019 [Google Scholar] [Crossref]

11. Kuehn, B. M. (2012). Integrated care key for patients with both addiction and mental illness. JAMA, 308(16), 1631–1632. [Google Scholar] [Crossref]

12. Kumar, V., & Cheng, S. Y. C. (2024). Integrated health services and the shift toward people-centred care: A contemporary review. Social Development Issues, 46(1), 1–15. [Google Scholar] [Crossref]

13. Lewis, R. Q., & Ehrenberg, L. (2022). Reconsidering integrated health services: A person-centred framework for contemporary health systems. International Journal of Health Policy and Management, 11(10), 2390–2399. [Google Scholar] [Crossref]

14. McHugh, C., Hu, N., Georgiou, G., Hodgins, M., Leung, S., Cadiri, M., … Lingam, R. (2024). Integrated care models for youth mental health: A systematic review and meta-analysis. Australasian & New Zealand Journal of Psychiatry, 58(9), 747–759. https://doi.org/10.1177/00048674241256759 [Google Scholar] [Crossref]

15. Melnick, E. R., Dyrbye, L. N., Sinsky, C. A., Trockel, M., West, C. P., Nedelec, L., Tutty, M., & Shanafelt, T. (2022). The association between perceived electronic health record usability and professional burnout among physicians. Mayo Clinic Proceedings, 97(3), 487–496. https://doi.org/10.1016/j.mayocp.2021.09.020 [Google Scholar] [Crossref]

16. Miller, K., Mosby, D., Capan, M., Kowalski, R., Ratwani, R., Noaiseh, Y., & Kraft, R. (2021). Interface design principles for usable decision support: A targeted review of best practices for clinical decision support. Journal of Biomedical Informatics, 117, 103761. https://doi.org/10.1016/j.jbi.2021.103761 [Google Scholar] [Crossref]

17. Obi A., Ekwok L., Nwanchor U, Obukoadata P. & Okoro J. (2024). Hit FM radio jingles on coronavirus and its edutainment values to listeners in Calabar Municipality. Scope 14 (04), 379-397 [Google Scholar] [Crossref]

18. Roshanov, P. S., You, J. J., Dhaliwal, J., Koff, D., Mackay, J. A., Weise-Kelly, L., Navarro, T., Wilczynski, N. L., Haynes, R. B., & CCDSS Systematic Review Team. (2021). Can computerized clinical decision support systems improve practitioners’ diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review. Implementation Science, 16(1), 15. https://doi.org/10.1186/s13012-021-01086-3 [Google Scholar] [Crossref]

19. SAMHSA (2024, June 10). Summary report on ISUDCC workgroups and recommendations for integrating harm reduction into the prevention, treatment, and recovery continuum of care. Substance Abuse and Mental Health Services Administration. [Google Scholar] [Crossref]

20. Singer, S. J., Shah, N. R., & Ivey, M. (2021). Toward fully integrated healthcare systems: Concepts, challenges, and opportunities. Health Affairs, 40(4), 601–608. [Google Scholar] [Crossref]

21. Sutton, R. T., Pincock, D., Baumgart, D. C., Sadowski, D. C., Fedorak, R. N., & Kroeker, K. I. (2020). An overview of clinical decision support systems: Benefits, risks, and strategies for success. NPJ Digital Medicine, 3, 17. https://doi.org/10.1038/s41746-020-0221-y [Google Scholar] [Crossref]

22. Systematic Review (2023). Integrated vs non-integrated treatment outcomes in dual diagnosis disorders: A systematic review. [Google Scholar] [Crossref]

23. Systematic Review (2024). Integrated behavioral interventions for adults with alcohol use disorder: A systematic review. (Note: RCT review) [Google Scholar] [Crossref]

24. Unützer, J., Harbin, H., Schoenbaum, M., & Druss, B. G. (2020). The Collaborative Care Model: An approach for integrating physical and mental health care in Medicaid health homes. Centers for Medicare & Medicaid Services. [Google Scholar] [Crossref]

25. Wendimagegn, N. F., & Bezuidenhout, M. C. (2019). Conceptualization of the integrated health service model to strengthen primary healthcare in low-income settings. BMC Health Services Research, 19(1), 1–15. https://doi.org/10.1186/s12913-019-4179-x [Google Scholar] [Crossref]

26. Wolitzky-Taylor, K., et al. (2023). Integrated behavioral treatments for comorbid anxiety and substance use disorders: A model for understanding integrated treatment approaches and meta-analysis to evaluate their efficacy. Drug and Alcohol Dependence, 253, 110990. [Google Scholar] [Crossref]

27. Wolitzky-Taylor, K., Tate, S. R., Buckner, J. D., & Feingold, Z. (2023). Meta-analysis of integrated treatments for co-occurring anxiety and substance use disorders. Journal of Anxiety Disorders, 95, 102650. https://doi.org/10.1016/j.janxdis.2023.102650 [Google Scholar] [Crossref]

28. World Health Organization. (2021). Integrated care for people-centred health systems: Policy and practice framework. WHO Press. [Google Scholar] [Crossref]

29. World Health Organization. (2023). Integrating mental health and substance use services in primary care: A global framework. Geneva: WHO. [Google Scholar] [Crossref]

30. Zonneveld, N., Driessen, N., Stüssgen, R. A. J., & Bal, R. (2020). Values of integrated care: A systematic review and Delphi study. BMC Health Services Research, 20(1), 1–18. [Google Scholar] [Crossref]

• Tribal Child Nutrition and Health in District of Sundargarh: A Public Health Review of ICDS Intervention
• Knowledge, Attitudes and Practices Towards Prostate Cancer Screening Amongst Men Aged 40-60 Years in The Buea Health District: A Cross-Sectional Study
• Compliance with JCI Protocols: A Focus on Employee Safety
• Influence and Involvement of Teachers in Menstrual Hygiene Management of Female Secondary School Students in Kogi State, Nigeria
• A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar