Young adults' access to mental health care: integrating the Primary Care Behavioral Health model into routine care in Sweden.

backgroundMental health issues among young adults are increasing. Swedish data indicate a three- to fourfold increase in symptoms of anxiety and distress over the past two decades. Access to mental health services in primary care is often hindered by long wait times and resource limitations. The Primary Care Behavioral Health (PCBH) model, characterized by brief, team-based interventions delivered by behavioural health consultants (BHCs), offers a promising approach to improve access. However, limited evidence exists on its impact on young adult populations.

methodsA pragmatic stepped-wedge cluster trial was used to evaluate the impact of facilitating PCBH integration on young adults aged 18-24 years in nine primary care centres in Region Östergötland, Sweden. Data were collected from medical records spanning three phases: pre-facilitation (year 1), facilitation (year 3) and post-facilitation (year 4). Year 2 measurements were excluded to avoid contamination because primary care centres were receiving information about the PCBH model during that period. This ensured that pre-facilitation data reflected conventional primary care conditions. Four outcomes were investigated: (1) number of unique patients, (2) number of BHC appointments by all patients, (3) average waiting times for all appointments, and (4) average waiting times for first appointments. The study was partially carried out during the COVID-19 pandemic. While the pre-facilitation phase occurred before the pandemic, the facilitation phase partially overlapped with it and the post-facilitation phase took place entirely during the pandemic.

resultsThe number of unique young adult patients accessing BHC services increased by 84% during facilitation (p < 0.001) and remained 25% above baseline post-facilitation. Total BHC appointments increased by 16% during facilitation (p < 0.001) and 13% post-facilitation (p = 0.006). The steepest increase was in remote consultations. Average waiting times for all appointments decreased from 14.1 to 11.8 days during facilitation (p < 0.001), and reductions were sustained post-facilitation (13.4 days, p = 0.007). In-person first appointment waiting times also decreased significantly during and after facilitation (both 7.1 days versus 8.8 days at baseline; p < 0.001).

conclusionsIntegrating the PCBH model into routine primary care improved access to mental health services for young adults, as demonstrated by increased utilization and reduced waiting times. The findings highlight the model's potential for scalable, team-based mental health delivery in primary care. However, decreases post-facilitation suggest that sustained implementation support may be important for long-term impact. It is important to note that the lack of a comparison group precludes definitive conclusions regarding the effects of the model, as alternative explanations for the observed changes cannot be ruled out.