The UNC Department of Family Medicine has launched UNC Health’s first private practice-based Primary Care Behavioral Health Collaborative, embedding critical mental health services directly into a primary care practice to improve access, reduce stigma, and intervene earlier for patients across the lifespan. The initiative, based at UNC Health Family Medicine and Pediatrics at East Pittsboro, is years in the making and is made possible by generous donor support that bridges persistent gaps in behavioral health reimbursement.
Our nation faces a behavioral health crisis. One in five Americans experiences mental health challenges, yet many go undiagnosed and untreated. Suicide rates have surged, making it a leading cause of death among young adults, a stark reminder of the urgency for action. In North Carolina, access to essential mental health services remains critically limited. Under today’s fee-for-service model, many insurance plans fail to adequately cover behavioral health care, leaving patients vulnerable and underserved.
Early Impact: “Next‑Level Care” Through Warm Handoffs
Erik Butler, DO, Medical Director at East Pittsboro, and Jacqueline Fuentes, LCSW, Behavioral Health Consultant and Licensed Clinical Social Worker Supervisor, are leading the charge to bring new integrated mental health care to life at the clinic. Fuentes is a vital community resource for patients and providers alike, offering short-term therapy and real-time consultations in the clinic through warm handoffs.
“This collaborative model ensures that patients facing mental health challenges like depression, anxiety, trauma, bereavement, substance use, or other behavioral issues impacting chronic conditions receive timely, compassionate support,” Butler said. “Jacquie (Fuentes) has transformed how we care for patients. The ability to recognize behavioral health needs and immediately connect patients with her has been next-level care. In just six weeks, we’ve collaborated more than I have cumulatively with mental health specialists in my career.”
Fuentes added, “Primary care creates a more destigmatizing entry point for behavioral health. I’ve supported older adults experiencing therapy for the first time and helped caregivers navigate complex challenges.”
Program Structure and Measurement
The program gives patients access to short-term counseling – up to eight sessions – right in their primary care clinic, while keeping a long-term connection through regular visits with their doctor. This means patients can get help quickly without the stress of finding a separate mental health provider. To understand how well the program works, the team is tracking metrics such as how often patients are introduced to the behavioral health specialist during a visit (a “warm handoff”), how many counseling sessions are scheduled, and other types of support provided. They also surveyed patients and providers before the program started and will check back in after a year. In addition, the team will look at whether this approach helps people get care faster, reduces emergency room visits and hospital stays, and improves overall health compared to patients who don’t receive behavioral health support.
Built on UNC Family Medicine’s Leadership in Behavioral Health Integration
The collaborative builds on UNC Family Medicine’s long-standing commitment to integrating behavioral health into primary care. The department has a nationally recognized residency training model, led by Linda Myerholtz, PhD, supported by grants for behavioral health integration. This embeds behavioral health education and team-based care into the curriculum for future family physicians to deliver whole-person care in diverse, real-world settings. These efforts complement faculty leadership in the UNC Behavioral Health Workforce Research Center, directed by Briana Lombardi, PhD, MSW, to strengthen the behavioral health workforce nationwide.
A Legacy of Whole‑Person Care
This initiative honors Dr. James B. Holt, who served Chatham and Lee counties for more than 40 years. Dr. Butler worked with Dr. Holt, seeing patients in Pittsboro, and the collaboration carries forward Holt’s philosophy of compassionate, whole-person care. The Dr. James B. Holt Endowment supports the sustainability and expansion of behavioral health services at East Pittsboro.
“Dr. Holt modeled non-judgmental care,” Butler said. “This program keeps that spirit alive – integrating behavioral health as an essential part of primary care for our community.”
Why Donor Support Matters
The Primary Care Behavioral Health Collaborative at East Pittsboro Family Medicine and Pediatrics is a first-of-its-kind model within UNC Health, bringing behavioral health specialists directly into primary care through a partnership among UNC Faculty Practice, UNC Health Medical Group, the UNC Health Foundation, and private donor support.
Adam Goldstein, MD, MPH, Goodwin Professor of Family Medicine at UNC, helped link interested donors with this new model. “Traditionally, great programs like this have been challenging to fund under current reimbursement structures, and we could not move forward without support to sustain the model. Linking interested donors with embedded mental health resources struck a positive chord among community members.” Goldstein said.
Behavioral health remains one of the most underfunded areas in healthcare. “Our dream is that one day every practice will have an embedded behavioral health specialist,” Butler added.
UNC Health hopes to replicate this model across practices statewide. Potential donors interested in this model to hire full-time behavioral health professionals in community-based practices can contact the UNC Health Foundation at 919-445-6696 or give towards these efforts here.
If you would like more information, please contact Reid Johnson at reid_johnson@med.unc.edu.
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