A mental health specialist provides triage to a soldier during a behavioral health assessment. (U.S. Army photo by Staff Sgt. Christopher Calvert)

When Frances stepped on the scale at her primary care visit, she had gained more than 10 pounds. She was under a lot of stress, she told the physician assistant.

The response was immediate: A new member of the primary care team could help Frances with a plan for coping with stress. Minutes later, she was sitting down with internal behavioral health consultant Erica Jarrett. Six months later, not only was Frances less stressed, but she’d also lost the extra weight.

Frances (not her real name) is benefiting from the Military Health System’s decision to integrate an internal behavioral health consultant (IBHC) -- either a psychologist or a licensed clinical social worker -- into the primary care team. For the military, the goal is healthier, fitter service members.

IBHCs add a new dimension to patient-centered medical homes, primary care units that house a team of medical specialists. The Deployment Health Clinical Center aims to help the military’s patients with health concerns such as diabetes and high blood pressure as an adjunct to other treatments. An important goal for the medical homes is to enable patients to adopt healthier lifestyles.

Of course, high blood pressure and other chronic health concerns are also problems in the civilian world, and doctors outside the military are watching to see how well the Defense Department succeeds with this new approach. Already, medical homes are offering lessons in team-based care for civilian providers, researchers say.

For service members, the medical homes are rapidly becoming one-stop health care shopping, making it easy for those with conditions including not just high blood pressure but also diabetes, obesity and high cholesterol to develop plans for making needed lifestyle changes.

For example, in addition to taking medication someone with high blood pressure needs to adopt a number of lifestyle changes to include “implementing a DASH (dietary approaches to stop hypertension) diet, exercise and management of stress,” said Jarrett, the interim chief of health psychology at Walter Reed National Military Medical Center in Bethesda, Maryland. She helps service members, dependents and retirees develop plans to incorporate healthy behaviors, and encourages them to start immediately.

“I ask what small change they can make before the next visit,” Jarrett said.

Jarrett provides a necessary service, according to Jennifer A. Thorp, a physician assistant at Walter Reed. “We definitely value her and her techniques. It helps us explain to the patient why changes are important and how to incorporate them.”

Beyond physical health, Jarrett and more than 200 other behavioral health consultants already stationed across the country can help patients with mental health concerns such as depression and anxiety before they reach a critical point. In addition to the behavioral health consultant, the military’s medical homes also include a nurse care facilitator who follows up with patients on their progress.

“Most individuals don’t go to behavioral health care when they’re suicidal. They go to primary care,” Jarrett said. Behavioral health consultants can screen patients in the course of a wellness visit and refer them to specialty care if needed.

“We’ve treated a number of people who were either planning suicide or thinking about it,” she noted.

Warfighters are also responding well to the notion that some mental health conditions can be treated with behavioral changes if they’re caught early enough. Patients with depression, for example, can break its downward spiral by doing things like exercising more, planning and doing activities they enjoy, and addressing negative thoughts. IBHCs help patients learn to use their strengths to manage their symptoms.

“Often when people get stressed out, they stop doing things that are buffers for stress,” Jarrett said. “They stop going to the gym, stop taking care of themselves, stop engaging in pleasurable activities with friends or family. Before, none of this was an effort, but once you’re depressed everything takes more effort.”

She’s found this proactive, take-charge approach to health and mental health appeals to the program’s beneficiaries.

“I’ve had a lot of individuals who never saw a psychologist before,” Jarrett said. “They say they would have done it before if they’d known how much they’d like it.”

For more information on psychological health concerns, visit the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.