Depression is the leading cause of disability in the United States, and the traditional framework for managing depression within a psychiatry practice i.e., a single psychiatrist treating a single patient for up to an hour per week comes up painfully short at the level of serving the population even if it can be highly effective for individuals. At the same time, the non-systematic way in which most patients identify the need to see a specialty provider in behavioral health leaves many stranded, regardless of how complex their needs are. Primary care is now often considered the  de facto mental health system  in the United States, and primary care providers have been charged with the impossible task of making up for the dearth of psychiatric specialty providers and somehow correcting the many inequities in access to care that remain. Primary care providers shouldn t have to do this alone.