This case study presents CareSouth Carolina and Northeastern Rural Health Network, a group of organizations that have successfully partnered together to improve the behavioral health wellness of their patients and residents in rural South Carolina, specifically in Chesterfield, Dillon and Marlboro counties.

CareSouth Carolina, a Federally Qualified Health Center (FQHC) and one of the five rural health networks in the state, began the behavioral health integration process in the early 1990s utilizing a four-phase process composed of: addressing post-partum depression, addressing chronic disease and depression co-morbidity, addressing higher complexity behavioral health patients by hiring Licensed Independent Social Workers, and implementing a partnership in the 2000s with the Northeastern Rural Health Network to prevent behavioral health issues in the community.

A few key elements of the CareSouth Carolina Behavioral Health integration process that contributed to its success include:

1. Incorporating a behavioral health counselor in each primary care office to provide consultations to patients. This improved care coordination and increased the likelihood that patients receive the physical and mental health support they need in order to be healthy.
2. True integration that required excellent communication and understanding between behavioral health and primary health professionals.
3. Adherence to evidence-based processes using modern methods such as provider dashboards that publicly report outcomes of care, case managers who worked with non-compliant patients to address factors that make it difficult to adhere to treatment, and implementation of evidence-based guidelines for depression treatment and monitored outcomes.

A few key approaches of the partnership between CareSouth Carolina and the Northeastern Rural Health Network that made integration of primary care and mental health successful include:

1. Depression and chronic disease messaging in community screenings.
2. The Healthy Mind Body Alliance (sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA)) which placed primary care providers in the mental health settings in order to provide comprehensive primary care services.
3. Developing referral protocols across different departments.
4. Training community health workers in early detection of mental health crisis and first aid.

The goal of CareSouth Carolina and Northeastern Rural Health Network is to improve the behavioral health wellness of patients and residents.

The partnership between CareSouth Carolina and Northeastern Rural Health Network has reduced the stigma regarding mental health issues, improved care coordination, and increased the likelihood that patients receive the physical and mental health support they need in order to be healthy.

In 2015, CareSouth Carolina achieved 50% decrease in the PHQ9 (Patient Health Questionnaire for depression) score of 47% of its patients with major depression in a 4-month period. The integration has decreased mental health stigma, improved care coordination, and increased the likelihood that patients receive the physical and mental health support they need in order to be healthy. Furthermore, although CareSouth Carolina has implemented behavioral health integration in five counties, the best outcomes are found in the counties in which the Northeastern Rural Health Network is also present.