The Indian Health Service (IHS) Office of Clinical and Preventative Services, Division of Behavioral Health, is accepting applications for its Behavioral Health Integration Initiative (Short Title: BH2I) to plan, develop, implement, and evaluate behavioral health integration with primary care, community based settings, and/or integrating primary care, nutrition, diabetes care, and chronic disease management with behavioral health. This program is authorized under: The Snyder Act, 25 U.S.C. 13, and 25 U.S.C. 1665j. This program is described in the Catalog of Federal Domestic Assistance (CFDA) under 93.933.

IHS supports changing the paradigm of mental health and substance use disorder services from being episodic, fragmented, specialty, and/or disease focused to incorporating it into the patient-centered home model. Research has shown that more than 70 percent of primary care visits stem from behavioral health issues. Depression is the most common type of mental illness, currently affecting more than a quarter of the U.S. adult population. With major depression currently the second leading cause of disability, it is clear that primary care settings have become an important access point for addressing both physical and behavioral health care needs. In addition, American Indian and Alaska Native (AI/AN) communities experience alarming rates of suicide, alcohol and drug-related deaths, domestic and sexual violence, and homicide. Describing the burden of trauma within any population is difficult, however indicators in terms of socially destructive behaviors are often used to illustrate this public health issue that creates impact through lifespan accumulation and chronic stress. Studies now indicate that resulting trauma from such events can even be passed from one generation to the next, resulting in intergenerational and historical trauma. While mental health needs can often go untreated and even unnoticed, the lasting effects of childhood trauma into adulthood is often evident in physical manifestations leading to negative health consequences. These extreme disparities highlight an urgent need for improving access to mental health services in primary care for children and families through the integration of behavioral health services, including trauma-informed care, within primary care settings. In addition, recognizing that behavioral and physical health problems are interwoven, delivery of behavioral health services in primary care settings reduces stigma and discrimination, and the majority of people with behavioral health disorders treated within an integrated primary care setting have improved outcomes.