The Value of Mental Health Partnerships in Oncology Practice

Cancer care involves multiple disciplines, including psychiatry and psychotherapy. Marketing emphasizes the physical and emotional “fight” or “battle” each patient endures while receiving treatment. With all of this, most oncology practices have yet to fully integrate mental health services into routine oncology care; in fact, one study showed that less than half of patients with advanced cancer and a psychiatric diagnosis accessed mental health care in the US.¹ This gap persists despite strong evidence linking psychological distress to a patient’s treatment adherence, symptom burden, and health care utilization.² As oncology increasingly shifts toward value-based models, the question is not whether mental health support is needed, but how to deliver it in a way that is sustainable, clinically meaningful, and financially viable.³

Why Integration Matters

Oncology appointments are dense with clinical decision-making, leaving little time to start a conversation about psychological well-being. Mental health affects 30% to 50% ofpeople with cancer, yet the majority never receive a formal mental health assessment, let alone treatment.⁴ The emotional burden of cancer can be substantial. Patients may experience anxiety, depression, adjustment difficulties, fear of recurrence, or other forms of distress throughout diagnosis, active treatment, and survivorship.^2,5 Access to timely mental health services is shaped by referral barriers, coverage limitations, reimbursement rules, and operational constraints.^6,7 These concerns can influence how patients understand information, participate in decision-making, and navigate the demands of care. Many clinicians are not trained to fully regard psychosocial care; also, some patients fear the stigma associated with a mental health referral. For those patients who do not believe treatment is available or distrust unfamiliar providers, integrated mental health support can help practices address these issues in a structured, timely manner rather than relying on ad hoc referrals after symptoms worsen.

Operational Value for Practices

In oncology practices, limited appointment time is devoted to imaging results, treatment sequencing, and management of adverse effects. Having a mental health partnership creates direct access to a complete mental health consultation by reducing pressure on clinicians who may otherwise need to manage complex emotional concerns within brief visits already heavily focused on treatment decisions. When oncology practices have a reliable mechanism for addressing psychosocial needs, they are better positioned to support both clinical efficiency and patient experience.

Why Hesitation Is Common; What Helps Overcome It

Initial hesitation is understandable. Practices often have concerns about staffing, reimbursement, billing complexity, patient uptake, and the operational demands of introducing a new model of care. In many settings, the challenge is how to implement it in a way that is sustainable and aligned with existing practice infrastructure, especially in oncology environments where teams are already managing significant clinical volume and complexity. Reimbursement for nonphysician mental health professionals is often lower than for physicians, and many of the clinicians who provide psychosocial oncology services are psychologists, social workers, clinical nurse specialists, or trainees.^8,9 This creates financial disincentives for practices, particularly those serving Medicaid populations. Additionally, coverage denials for supportive care services, including mental health interventions, remain common and contribute to delays in care and increased administrative burden. These payment differences can make it difficult to support the level of care patients need. Even when services are clinically appropriate, cost and administrative hurdles can delay or limit access.

The Payer’s Role and Engagement

Reimbursement policy, coverage design, and billing requirements often shape whether psychosocial services are available at the point of care or remain difficult to access. Coverage is determined through coding frameworks and reimbursement schedules that often undervalue behavioral health services related to procedural care. This integration cannot be sustained if payment does not support it. Limited reimbursement and complex billing requirements continue to restrict behavioral health availability and make colocated care more difficult to maintain. Recent Medicare billing trends for collaborative care and behavioral health integration models suggest growing attention to reimbursement pathways that support mental health services in oncology settings. This is why broader payer participation is necessary to make the integrated care routine successful. The payer’s role would resolve most of the issues mentioned when integrating mental health services.

A successful partnership will define roles, establish clear referral pathways, and deliver measurable value for patients and clinicians alike. A 2026 study in JAMA Network Open examined trends in Medicare billing by oncologists for integrated mental health care services, specifically the collaborative care and behavioral health integration models, which have distinct reimbursement pathways.⁸This suggests growing attention to how reimbursement structures can support integrated mental health care in oncology settings. Payers play a central role in determining whether integrated mental health support can be sustained over time and whether policy changes are needed. Payers have a strong incentive to participate in this conversation. Psychological distress can affect patient experience, care utilization, and the affordability of mental health services, all of which have implications for outcomes and cost. Supporting integrated mental health care in oncology aligns with broader efforts to improve whole-person care, reduce fragmentation, and ensure that patients receive timely support when it is most needed.

Author Information

Justin Dam, DO, is a PGY-1 at Medical City North Hills in North Richland Hills, Texas. Anayan Vennam received her BSA from The University of Texas at Austin. Morvarid Rezaie, DO, MD, HMDC, FACOI, is a board-certified palliative care physician at The Center for Cancer and Blood Disorders, a multisite community oncology practice based in Fort Worth, Texas.

References

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