Impact of Primary Care Mental Health Management on Emergency Psychiatric Presentations: A Systematic Review.

Primary care-based mental health management has been proposed as a strategy to reduce preventable psychiatric crises and lessen reliance on emergency departments, yet its impact remains uncertain across different populations and health systems. This review synthesized evidence from observational and quasi-experimental studies evaluating integrated, collaborative, or behavioral health home interventions within primary care and their association with emergency psychiatric utilization. Nine eligible studies were identified from a comprehensive search, most involving co-located or integrated behavioral health services aimed at improving continuity and outpatient engagement. Overall, interventions demonstrated consistent trends toward fewer psychiatric emergency visits, enhanced follow-up care, and better support for individuals with serious mental illness, although effect sizes varied and several studies were limited by methodological weaknesses such as confounding and selection bias. Two higher-quality studies showed moderate reductions in all-cause and psychiatric emergency use, while others reported mixed or modest effects. Collectively, the findings suggest that integrated primary care mental health approaches hold promise for reducing emergency presentations, but stronger, well-controlled research is needed to clarify which models yield the most meaningful and sustained reductions in acute care utilization.