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Few studies are available to guide how best to integrate mental health care into outpatient VA medical specialty clinics. The 2 most relevant studies both used specialty-clinic modifications of the successful VA primary care clinic intervention Translating Initiatives in Depression into Effective Solutions (TIDES).
A small proportion of Veterans account for nearly half of Veterans Affairs costs, most of which is hospitalization for medical (not mental health) conditions. But, almost half of such patients have a major mental health diagnosis. These mental health conditions, many of which are potentially treatable, are risk markers (and potentially risk factors) for future emergency visits and admissions for ambulatory care-sensitive conditions. Thus, better identification and treatment of mental health conditions can improve not just mental health but physical health as well. VA has embarked upon integrating mental health care into select outpatient specialty clinics and is seeking a review of published evidence of successful models.
The findings from this review of 16 publications are that: 1) there are no published studies relevant to VA of full collaboration in a transformed/integrated practice for integrating mental health into specialty clinics; 2) there are only 3 published studies of close collaboration approaching an integrated practice or close collaboration onsite with some system integration (in other words, anything greater than basic collaboration); 3) the studies most relevant to VA (done in VA settings) had interventions based on TIDES, modified for specific diseases (liver disease and HIV).