Integrated Behavioral Health: Taking Care of the Body and Mind

A Virginia Mason patient for 32 years, Tom Cyr visited his primary care physician with some familiar complaints. He had back pain, a side effect from a hard physical career, and his damaged knee – a decades-long condition requiring multiple surgeries – threatened to derail daily life. Tom’s doctor addressed those problems but was equally concerned about signs he wasn’t coping.

Annual Report - Primary Care“I was down,” remembers Tom. “Bad things had happened in my personal life. My doctor felt it even more than I knew it.”

Tom got an appointment that day with Megan Bott, LICSW, outpatient and Emergency Department social work supervisor, through a program integrating behavioral health care with primary care. Under the previous system, a patient might get in touch with social services by phone, and that’s where most interactions took place. Integrated services mean patients like Tom can see a social worker right away, for assessment and short-term counseling if needed.

Megan and Tom decided to meet regularly to start some basic cognitive behavioral therapy. Megan describes it as practical, skill-based therapy focused on identifying disabling thought patterns, reviewing what’s worked in the past and trying new approaches for problem-solving. Patients may have up to eight visits with the social worker, and be referred for continued mental health care when more support is needed. Megan and her two social work colleagues – covering Virginia Mason’s downtown Seattle and Kirkland locations – also provide crisis counseling, assistance to seniors, caregiver support, resources for people with special needs, and referrals for those dealing with abuse or addiction.

“For a primary care provider who realizes their patient is in distress, we offer a ready resource to support a variety of issues, often just in time,” says Megan. “After a diagnostic evaluation, we work closely with the physician, sharing observations and coordinating treatment to meet more of the patient’s needs.”

Forced into early retirement due to health problems, Tom was already struggling when the death of one family member and serious injury to another left him feeling hopeless and adrift. In sessions with Megan, Tom revealed an interest in volunteering, but didn’t know where to start. Megan told him about volunteer opportunities at Virginia Mason and offered to help with the paperwork. Soon Tom had a volunteer badge and a new-found expertise preparing large mailings for the medical center.

“The volunteer work was my savior through the holiday months last year,” remembers Tom. “Megan helped me with a lot of things I couldn’t cope with at the time. I probably would’ve been in my doctor’s office every other week and that wouldn’t have solved the problem.”

After Tom’s counseling sessions with Megan, a referral to psychiatry was planned but not needed. Tom says they both figured he’d graduated. Still a dedicated volunteer, Tom’s looking forward to his upcoming partial knee replacement that should have him walking pain-free. “But Megan made it clear her door’s still wide open,” says Tom.

A version of this story originally appeared in the 2016 Virginia Mason Health System Annual Report. 


  1. Lynnrauma says:

    I wish the 8+ years being treated with a life changing chronic illness at VM Sea, that there had been ANY groups for chronic illness, education, or any available psychology or psychiatrist available or worked with the effects of dealing with chronic illness. They left me with no speciatist care when my husband was determined a totally disabled Veteran and they wouldn’t take supplemental Champ Va. Happy you got very good care though!

    • Dear Lynn: We appreciate your feedback and I will pass it along to our Patient Relations team. While the care you described may be in the past, we want to know when the care we provide falls short to help plan our ongoing improvement work. Currently we are building a strong palliative care team that supports both inpatients and outpatients in a variety of ways to ease the burden of chronic illness. I’m sorry your husband’s care ultimately didn’t meet your expectations. Best wishes to you and thank you for taking the time to comment.
      Jennifer S. / Blog editor

  2. Rachael B says:

    I am so glad that Megan was able to help! She is an amazing asset to our patients and staff here at VM. We are all so lucky to have her as apart of the VM team!

  3. Is this service something that specialty care can utilize as well? My department makes a fair number of referrals for social services, and if the provider is able to screen for urgent need, it would certainly be helpful to have same day services initiated.

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