Health Services Research & Development

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Mental Health

Primary Care-Mental Health Integration Improves Care for Veterans with Mental Illness

September 7, 2018

To improve access to mental healthcare, VA underwent a large-scale implementation of team-based primary care models through Primary Care-Mental Health Integration (PC-MHI) beginning in 2007. Both VA medical centers and community-based outreach clinics (CBOCs) are now mandated to have PC-MHI services to enhance access and continuity of mental healthcare for Veterans, particularly those who live in rural settings. PC-MHI embeds nurse care managers and mental health specialists (i.e., psychologists, social workers, licensed mental health counselors) in primary care settings to provide brief evidence-based treatment to patients with low-to-moderate complexity mental health conditions. HSR&D investigators have conducted several studies to evaluate PC-MHI, including the following:

  • HSR&D researchers examined the relationship between primary care clinic engagement in PC-MHI and patient use of different mental health services (MHS). Results from this study showed increasing clinic engagement in PC-MHI services over time, accompanied by a reduction in general MHS visits – but no change in more specialized mental health services. These results suggest that PC-MHI programs reduce reliance on general MHS clinics, and that PC-MHI may be effective in engaging those reluctant to seek mental healthcare.1
  • Another study found that Veterans who received same-day PC-MHI services had more than twice the odds of receiving a subsequent mental health encounter within 90 days compared with Veterans who did not receive same-day services. Overall, 48% of the Veterans in this study had a subsequent visit for a mental health condition within 90 days of their initial visit. Among those with same-day PC-MHI, 74% had a follow-up, as compared to 45% who did not receive same-day services.2
  • HSR&D researchers also examined whether the PC/MHI program is associated with the retention of OEF/OIF Veterans with complex medical and psychological needs within the VA healthcare system. Results from this study examining the lag time between a Veteran’s first PC-MHI visit and next mental/medical care visit show that there was a significant association between the PC-MHI program and OEF/OIF Veterans’ receipt of short- (subsequent year) or long-term (four years later) mental or medical care. Of the 181 Veterans who participated in the PC-MHI program, 60% sought mental health care within one month after their initial encounter, and 82% after one year, while 18% sought medical care within one month, and 74% within one year.3