It may come as a surprise, but mental health concerns are often shared in the primary care setting. Given the stigma that some may feel about visiting the behavioral health department or the distrust in sessions being confidential, mental health needs are often disclosed in medical appointments. For American Indians seeking behavioral health care services, the stigma associated with disclosing mental health needs is perhaps even more heightened due to other social factors. There may be cultural expectations of not discussing issues with others outside of the home, fear of bringing more illness or disease if it is discussed, or even societal influences that there is something “wrong” with you if you seek behavioral health services. Without an integrated healthcare setting, these mental health concerns may not be assessed or treated as appropriately as they need to be.