Table 3: Emergent codes.

CodeDefinition

(A) LeadershipLeadership does/does not provide direction, coordinate between different services, obtain needed resources, make timely decisions, communicate with staff.
(B1) Resources (space)Lack of space includes barriers due to physical structure of facility, includes lack of space and distance barriers.
(B1) Resources (staffing)Not enough staff available to provide coordinated mental health care.
(B1) Resources (knowledge and skills)Specific mention of staff knowledge, skills, or abilities. It includes general comments such as “good staff”
(B2) TrainingTraining for MH procedures, including training of admin personnel
(B3) Work designIntentional choices regarding how care is provided; description of how tasks are divided between staff and/or clinics including informal systems work systems designed to overcome other barriers, including mandated tasks and same day appointments
(C1) PC/MH boundariesPerceived physical and/or psychological barriers between primary care and mental health clinics provide barriers to care.
(C2) Time pressureOverworked staff, working through admin/lunch time
(C3) Staff participationStaff “buy-in”, perceptions of mutual PC and MH participation, comfort with PC/MH referrals. It includes the use of formal and informal meetings to increase participation.
(D) Referral systemsProcesses used to coordinate care may include specific barriers to the referral process. It including the use of electronic medical record, paging systems, checklists.
(E) CommunicationInterpersonal communication, communication between PC and MH.
Patient complexityChallenges due to complicated mental health conditions and/or medical comorbidities; patients have many health needs, including noncompliance issues