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

• Another study sought to determine the association between the co-location of primary care services and quality of medical care for Veterans with serious mental illness (SMI) who were receiving care in VA mental health clinics. Findings show that the co-location of primary care services within VA mental health clinics was associated with better quality of care for Veterans with SMI. For key processes of care, after adjusting for organizational and patient-level factors, Veterans from co-located clinics were more likely to receive diabetes foot exams and screening for colorectal cancer and alcohol misuse, and to have satisfactory blood pressure control (an outcome measure).⁴
  

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  1. Leung L, Yoon J, Escarce J, et al. Primary care-mental health integration in the VA: Shifting mental health services for common mental illnesses to primary care. Psychiatric Services. April 2018;69(1):403-409.
  2. Bohnert K, Pfeiffer P, Szymanski B, and McCarthy JF. Continuation of mental health care following an initial primary care visit with a mental health diagnosis in VHA: Differences by receipt of primary care-mental health integration services. General Hospital Psychiatry. January 2013;35(1):66-70.
  3. Tsan J, Zeber J, Stock E, Sun F, and Copeland L. Primary care-mental health integration and treatment retention among Iraq and Afghanistan War Veterans. Psychological Services. November 2012:9(4):336-348.
  4. Kilbourne A, Pirraglia P, Lai Z, et al. Quality of general medical care in patients with serious mental illness: Does co-location of services matter? Psychiatric Services. August 2011;62(8):922-928.

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