Inside a First Collaborative Care Appointment

BREVARD COUNTY, FLORIDA – I hear it all the time when patients come in for their first appointment: they picture a dimly lit room, a long leather couch, and a therapist silently scribbling notes while they unravel their entire life story.

That’s the image many people carry into their first mental health visit.

The reality is much simpler. We don’t have couches, and no one is expected to sit down and share their entire life story during that first visit.

As a behavioral care manager with Health First’s Collaborative Care program, my role is to bring mental health support directly into primary care.

What often surprises patients is how practical and approachable the program feels. Instead of walking into a separate mental health clinic, they’re visiting the same doctor’s office they already know.

For many people, that alone removes a big layer of stress.

Patients usually meet with me after being referred by their primary care provider. Our appointments can happen in person or remotely, depending on what works best for them.

Some people prefer to come into the office, while others feel more comfortable talking from home. Either way, the goal is the same: provide focused, compassionate support that feels manageable.

When we begin that first session, the conversation is very straightforward.

I usually start by explaining the collaborative care program and why their provider recommended it. From there, we talk about what’s been going on recently, such as mood, stress, sleep, or anxiety. It’s not an interrogation, and it’s not about analyzing someone’s entire past.

It’s focused on what’s happening right now and what small changes we can make that make a positive impact.

At the start of the visit, patients fill out two short questionnaires. One looks at depressive symptoms over the past two weeks, and the other measures anxiety.

The scores from those questionnaires help create a starting point.

Those numbers matter more than people realize.

They allow us to track progress in a measurable way. When someone is dealing with stress or depression, improvement can feel slow or invisible in everyday life. But when we compare those scores over time, patients can often see changes they didn’t notice before.

The data becomes a reminder that progress is happening, even if it’s gradual.

By the end of that first session, most patients identify one or two small, manageable goals. We also outline the next steps. The structure helps people feel supported without being overwhelmed.

Collaborative care is designed to be short-term. Most patients meet with me for about four to six sessions spaced a few weeks apart. In between visits, I check in when needed. If someone requires more intensive therapy or a higher level of care, we work on connecting them with the right resources early.

The important thing is that patients aren’t navigating the process alone.

I work closely with their primary care doctors, so we’re coordinating care behind the scenes. They’re not managing it by themselves and it really is a team-based approach.

That coordination may also include a psychiatric consultant who can weigh in on medication questions if needed. Instead of patients repeating their story to multiple providers, communication happens within the same health system.

For many people, especially those seeking mental health support for the first time, that integration makes a huge difference. They’re sitting in a familiar doctor’s office. No one in the waiting room knows why they’re there. There isn’t a separate clinic that might carry stigma.

Still, there are a few common misunderstandings I hear from patients.

One of the biggest fears is that being referred to collaborative care means something is seriously wrong. It doesn’t. It simply means the primary care provider wants to give the patient extra support for stress, anxiety, depression, or life challenges.

I often compare it to seeing a specialist for blood pressure or diabetes. It’s simply another form of care — preventative care for emotional health.

Another concern comes from one of the questions on the depression questionnaire. It asks about thoughts of being better off dead or hurting oneself. Some patients worry that marking anything other than zero will automatically trigger an involuntary hold or, in Florida, a Baker Act.

That’s not what I’m here to do. Just because a patient circles something other than zero doesn’t mean I’m here to lock them up. I’m here to process it and talk about it with them.

Honesty is one of the most important parts of the process, and it goes both ways. I’m always straightforward with my patients, and I encourage them to be just as open with me.

I tell them, “Be honest with me. I’m not going to tell you a lie.” The more openly patients share how they’re really feeling, the better I can understand what they’re going through and help support them.

We work together to build coping skills, create safety plans if needed, and identify support systems.

Progress in collaborative care usually doesn’t look dramatic. There aren’t movie-style breakthroughs. Instead, I encourage patients to take the small win.

Maybe they’re sleeping a little better. Maybe work feels less overwhelming. Maybe they tried a coping strategy we talked about and discovered it helped.

Because we track symptoms at each visit, patients can see those changes over time. I often pull up their earlier scores and compare them to their current ones.

“I’ll say, ‘Look at the improvement. You’re doing a good job,’” I tell them. Sometimes they smile.

Setbacks happen, too. Scores can rise and fall from one visit to the next.

“We’re human,” I remind them. “It’s normal to have a couple of bad days in a two-week span.”

Those moments become part of the conversation, not something to feel ashamed about.

For patients who want to explore collaborative care, the first step is often a conversation with their primary care provider. That can happen during an appointment, over the phone, or through MyChart, the secure patient portal powered by Epic.

Those messages go directly to the care team and can help start the referral process. For people who might feel hesitant to pick up the phone, the online system makes it easier to ask for help.

Sometimes a provider will suggest the program after routine screening during a visit. Other times, patients bring it up themselves.
And sometimes they decide they’re not ready yet.

That’s okay too.

“Patients know themselves best,” I say. “You have to want the help in order to be helped.”

More than anything, I want people to understand that collaborative care isn’t about labeling someone or placing them into a category.
It’s about connection.

It makes mental health feel normal. It’s not about labeling somebody. It’s about making sure they don’t have to navigate what they’re going through by themselves.

CHARISSA REYNOLDS, MSW, is a Behavioral Care Manager at Health First Medical Group who sees patients inside primary care exam rooms to discuss their mental health concerns, their medications, and what they can do to improve their moods or seek more intensive treatment with a psychologist or psychiatrist. 

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