Despite three-quarters of U.S. adults desiring mental health discussions during primary care visits, only a fraction actually get asked, revealing a significant gap between patient expectations and current clinical practices. Health systems are increasingly recognizing the need for holistic care models that embed mental and behavioral health screening into primary care workflows, but it is easier said than done. The most promising approaches involve training primary care providers to recognize mental health indicators, integrating social workers directly into care teams, and developing proactive screening protocols that capture patients who might not independently seek mental health support. This approach requires breaking down traditional silos between physical and mental healthcare, creating more seamless, patient-centered care pathways that normalize mental health conversations and ensure no patient falls through the cracks.