Veterans Health Administration Investments In Primary Care And Mental Health Integration Improved Care Access

By Lucinda B. Leung, Lisa V. Rubenstein, Jean Yoon, Edward P. Post, Erin Jaske, Kenneth B. Wells, and Ranak B. Trivedi: For More Info, Go Here...

Access to high-quality mental health services for patients followed in primary care settings has historically been suboptimal,¹ even though effective team-based treatments exist.² A recent multicenter study found that two-thirds of primary care patients with newly diagnosed depression remained untreated,³ which indicates that a change in current care delivery paradigms is needed. Because many patients diagnosed with psychiatric illness are first identified in primary care, are reluctant to consult mental health specialists, or both,⁴ there is a growing movement to offer integrated services where primary care providers, co-located mental health specialists, and care managers jointly treat patients in primary care.⁵ More than seventy-nine randomized controlled trials support primary care and mental health specialties collaboratively caring for depression, anxiety,² and other conditions (for example, substance use disorders).⁶ Although it has been over twenty-five years since the first effectiveness study, collaborative care models remain challenging to disseminate and implement among health care systems.⁷

Since 2007 the Veterans Health Administration (VHA) has invested in Primary Care–Mental Health Integration (PC-MHI) among clinics nationwide.⁸ The initiative aims to improve access to mental health services by embedding specialists, care managers, or both in primary care clinics to collaboratively care for veterans with psychiatric illness. PC-MHI includes essential collaborative care elements in that the models are team driven, population focused, measurement guided, and evidence based.⁵ The VHA requires implementation of the program in all of its primary care clinics that care for 5,000 or more patients annually.⁹ It provides national PC-MHI resources in the form of technical assistance, education, training, and designated tools for quality improvement (that is, program workload monitoring, mental health staffing data, and annual program implementation surveys).⁸

Separately, in 2010 the VHA adopted patient-centered medical homes (Patient Aligned Care Teams, or PACTs)¹⁰ nationally, assigned each veteran to an interdisciplinary care team, and provided additional staffing and resources in primary care. Together, both the PC-MHI and PACT initiatives aim to deliver most mental health services directly in primary care settings to veterans with mild-to-moderate psychiatric illness. The initiatives target veterans with the mental health issues of depression, anxiety, and alcohol use disorder, but they may also address behavioral health issues (for example, chronic pain or sleep problems).¹¹ Primary care and PC-MHI providers aim to provide same-day personal introductions with patients. Alternative modes of communication include telephone calls between providers and between patients and providers; asynchronous (e-Consult) and instantaneous electronic communication between providers; and, more recently, synchronous video visits between patients and providers.¹