Skills vs. Pills

Skills Versus Pills

Can Integrated Behavioral Health Services Benefit Depressed Patients in Primary Care?

For decades, primary care providers (PCPs) were encouraged to prescribe antidepressant medications to depressed patients. They faced many barriers to referring their patients to behavioral health providers in the community, including cost, problematic access, and stigma. Patricia Robinson and colleagues conducted a randomized controlled trial comparing usual depression care with treatment enhanced by the addition of a behavioral health consultant (BHC) to the primary care team. Results suggested that patients served by BHCs had better clinical outcomes than usual-care patients.

A study published in the March 2020 issue of Families, Systems, and Health is a post-hoc analysis of data from the randomized controlled trial that looks at the effect of integrated behavioral health services on patient behavior change, patient and PCP satisfaction, and PCP support of BHC interventions after brief BHC involvement. Compared to usual-care patients, patients who received BHC services were more likely to use evidence-based coping skills, were more satisfied with their care for depression, and were more likely to see their PCPs as supporting their use of coping skills. The Figure below provides an overview of patient scores on the Coping Strategy Use Scale, in lower and higher symptom severity groupings, at pretreatment and follow-ups at 1, 4, and 7 months.

Today, BHCs are becoming more common in primary care. Perhaps the availability of a BHC to teach evidence-based coping skills will lessen the likelihood of patients receiving antidepressants as a routine first-line treatment.  The Coping Strategy Use Scale (see Table below) measures patients’ use of evidence-based coping strategies for depression. PCPs, BHCs, and nurses can use the scale as a screener for patients who present with possible depression. With a focus on positive behaviors, the Coping Strategy Use Scale may engage patients in care more than commonly used screeners that focus on counting depression symptoms. Promoting patients’ use of positive coping strategies is a first-line treatment with a strong potential for helping patients develop and maintain the skills they need to live meaningful and fulfilling lives.

Table: Coping Strategy Use Scale


Figure: Coping Strategy Use Scale Scores for BHC and UC Patients with Lower and Higher Severity Symptoms of Depression at Pretreatment and Follow-Ups

Coping Strategy Use Scale Scores for BHC and UC Patients with Lower and Higher Severity Symptoms of Depression at Pretreatment and Follow-Ups

Note. BHC = Behavioral Health Consultant; UC = Usual Care.


About the Author

Patti Robinson, PhD, is currently the President of Mountainview Consulting Group ( and provides consultation and training services. Mountainview was founded in 1998 and won the APA Presidential Innovative Practice Award in 2009. Earlier in her career, Robinson worked as a researcher and clinician for Group Health Cooperative in Seattle, WA and as a Behavioral Health Consultant for Yakima Valley Farm Workers Clinic.


Robinson, P. J., Von Korff, M., Bush, T., Lin, E. H. B., & Ludman, E. J. (2020). The impact of Primary Care Behavioral Health services on patient behaviors: A randomized controlled trial. Family Systems and Health, 38(1), 6-15.