Building a bridge between primary care practitioners and their mentalhealth colleagues is a major challenge today, especially in the care ofpatients who are immigrants from non-Western cultures. At The Charles B WangCommunity Health Center (formerly known as CHC—Chinatown Health Clinic),an innovative program called the Primary Care and Mental Health Bridge Programis dismantling the barriers to mental health care experienced by AsianAmericans. Asian Americans with mental disorders often do not receivetreatment until they are chronically ill or in crisis. They suffer from a lackof access to mental health professionals, including providers fluent in Asianlanguages, and from the pervasive stigma of mental illness in traditionalAsian cultures.

The Bridge Program is based on evidence showing the advantages of offeringmental health services in a primary care setting. Katon and colleagues showedthat such an approach could improve detection and clinical outcomes forprimary care patients with major depression.¹ This finding isparticularly important because primary care patients with mental disordersusually refuse treatment in specialty settings. More recent work by Wells andcolleagues of the Partners in Care Program confirmed the benefits of bringingmental health services to multiple primary caresettings.² Asupplement to the Surgeon General's Report on Mental Healthspecifically cites the work of the Bridge Program and recommends that modelslike the Bridge Program be replicated to improve access and care for ethnicminority patients with mental healthproblems.³(p163)

With the support of a Robert Wood Johnson Foundation Local InitiativeFunding Partners grant, the Bridge Program demonstrated the efficacy of usingthe primary care setting as a major access point for behavioral healthtreatment.⁴ Keyelements of the program are training primary care providers in the earlydetection and management of common mental disorders, educating the Asiancommunity about mental health issues, and giving practitioners thecommunications tools to offer culturally responsive care.

Making mental health care accessible and acceptable in the Asian Americancommunity is not easy. Depression and other common mental health disorders areoften masked as physical ailments by Asian patients, leading to misdiagnosisand less effective treatment. By training primary care providers to recognizethe physical symptoms of mental illness, prompt and more appropriate care ispossible.

As culturally sensitive physicians know, however, Asian American patientsmay not accept a behavioral health diagnosis. Traditionally, mental illness isseen as shameful for the individual and the family. The CHC model uses apractical new dialogue that respects the Eastern holistic definition ofhealth. By focusing on the concept of the mind and body being in balance,primary care practitioners can explain that mental stress can cause physicalsymptoms. Treatment to restore balance is then the key to diseasemanagement.

Integrating behavioral and primary care into the same setting reduces thestigma that Asian patients may associate with seeking mental health services.Patients in the Bridge Program reported that they were more comfortableentering a primary care facility than a psychiatric one and less hesitant toreturn for mental health careappointments.⁴

Since the Bridge Program began, Asian American patients in psychiatricdistress have received earlier diagnosis and treatment. Over a 3-year period,1,905 individuals were seen for mental health treatment or education,resulting in 5,324 total mental health visits. Mental health visits by primarycare providers had risen threefold over the 3 years. The total number ofmental health clinical encounters and the number of patients in whompsychiatric disorders were diagnosed more than tripled at CHC's initial threesites during thistime.⁴

Considering these results, the Health Resources and Service Administrationselected the Bridge Program as a winner of the Models That Work program in2000. This federal competition designates creative programs that respond tocommunity needs, improve health outcomes for a vulnerable population, and canbe replicated by other communities.

The RWJF Local Initiative Funding Partners program also recognizes effortsthat use innovative methods to deliver primary and preventive health care tounderserved populations. Most importantly, these projects are expected toserve as new prototypes. Because of such results, the Bridge Program has beenrecognized as a prototype for other populations in other areas. Programs inBoston, Seattle, and Oakland have started to adopt the Bridge model.