Program Improves Access to Mental Health Care for Veterans
Difficulties in accessing mental health care have led primary care to become a “defacto” mental health system in the United States. Although screening for mental illness in primary care has increased in recent years, subsequent treatment remains inadequate and referral for specialty treatment continues to suffer from long delays.
Faced with these delays, the mental health service at one VA medical center developed an innovative program that shifted specialized staffing into an existing mental health clinic in primary care and added advanced clinical access. This article discusses the implementation and outcomes for the first four years of the “Primary Mental Health Care Clinic” (PMHC) program in primary care, begun in 2004. The PMHC incorporated four main principles: 1) mental health providers should be part of the primary care team; 2) care should be flexible to meet the needs of providers and patients; 3) access to care should be immediate, with no scheduled appointments; and 4) most veterans should be able to receive all the mental health care they need without referral to more comprehensive care.
Findings show that the waiting time for new appointments was shortened from a mean of 33 days to 19 minutes. Clinician productivity and evaluations of new referrals more than doubled. Patient satisfaction was measured during the first year, with 99% of veterans expressing good to excellent satisfaction with care. In addition, the program has reduced the number of veterans referred into the specialized mental health clinic, thus conserving resources. These improvements have been sustained over four years.
Pomerantz A, Cole B, Watts B, Weeks W. Improving efficiency and access to mental health care: Combining integrated care and advanced access. General Hospital Psychiatry November/December 2008;30(6):546-551.
All authors are part of the White River Junction VA Medical Center.