2012 HSR&D/QUERI National Conference Abstract
3032 — Implementation of Coordinated Mental Health Treatment in Primary Care
Benzer JK, Cramer IE, Sullivan JL, Mohr DC, and Burgess JF, COLMR, VA Boston Healthcare System;
Explore and interpret the experiences of primary care (PC) and mental health (MH) staff regarding PC/MH Integration (PC/MHI) implementation one year after the VA mandate and describe barriers and facilitators to implementation.
Data were collected in response to a call from an operational partner to evaluate the implementation of integrated mental health care in selected PC clinics. Data from 65 PC and MH staff interviews across 16 sites were analyzed to identify how coordination was perceived one year after the PC/MHI implementation mandate.
MH staff reported that enhancing the involvement of PC providers was critical to PC/MHI effectiveness. Both PC and MH indicated that communication was important for PC/MHI, but the two services described different reasons for why communication was important. Additionally, MH staff viewed leadership involvement as necessary to achieve co-location that could in turn increase both communication and PC involvement. PC providers viewed co-located MH staff as a resource to provide access to MH care that was otherwise protected by standardized process barriers. Additionally, PC saw co-location as important for collaborative care, but co-location was limited by physical space.
The intervention appears to be successful to the degree that it provides new options for MH care within PC. MH providers reported being engaged in encouraging primary care provider involvement in the intervention. PC staff reported standardized process barriers, and described how co-located MH providers helped improve specialty MH care access. When successful, PC/MHI may decrease the demand for specialty MH care, but also provide a mechanism to gain access to MH specialty care when needed.
This study demonstrates the importance of consulting all stakeholder groups when designing, implementing, and evaluating interventions that affect multiple disciplines. In many sites, the implementation of PC/MHI was planned by mental health with little input from PC. These findings are particularly relevant to the ongoing implementation of Patient Aligned Care Teams (PACTs) as coordinators of Veterans’ primary and specialty care needs. These types of multi-disciplinary interventions are complex, with the implications for multiple stakeholder groups not immediately obvious to those responsible for implementation.