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VA research in action
Integration of mental health care into primary care
March 1, 2022
Photo: ©Getty Images/ Cecilie_Arcurs
Research in Action
Mental health challenges such as PTSD, depression, anxiety, and substance use are common among Veterans.
To improve VA’s ability to care for Veterans with mental health problems, especially those returning from the wars in Iraq and Afghanistan, the department launched a National Primary Care-Mental Health Integration Program (PC-MHI) in 2007. The program integrates mental health staff into patient-aligned care teams (PACTs). VA researchers played an integral role in the development and evaluation process of PC-MHI, which has improved care and outcomes for many Veterans.
PACTs are partnerships between Veterans enrolled for care with VA and their health care professionals to provide for whole-person care and lifelong health and wellness. Because mental health staff is now integrated into every PACT, care teams can provide Veterans with services for depression, anxiety, PTSD, and substance use issues without their needing to visit a separate mental health clinic.
Influential studies from early 2000s
VA researchers began studying this care approach even before the wars in Iraq and Afghanistan began. A 2001 study by researchers at the Portland VA Medical Center reported on a program at the facility to teach psychiatric residents how to provide integrated psychiatric and medical care in a primary care setting. Patients, psychiatric residents, and medical faculty all reported a high degree of satisfaction with the initiative.
Another 2001 study, by researchers with the VA Connecticut Health Care System and Yale University, compared care results for 120 Veterans enrolled in a VA mental health clinic. Half received primary medical care in an integrated care clinic located in the mental health clinic, and the other half received care in the facility’s general medicine clinic. The team found patients treated in the integrated care clinic had significantly greater improvement in their health status, although there were no significant differences between the two groups in any of the measures of mental health symptoms.
In 2004, researchers with the VA Puget Sound Health Care System published the results of a study evaluating the effects of establishing a multidisciplinary mental health primary care team in an internal medicine primary care clinic at the Seattle VA Medical Center. The team found that a multidisciplinary mental health primary care team can quickly evaluate and stabilize patients with a wide range of psychiatric disorders, reduce the numbers of referrals to specialty mental health care, and improve collaborative care for patients.
Evaluating integrated care
Today, all VA facilities have mental health professionals working within their primary care clinic, allowing for instant access to consultations and brief therapy for patients with mental health or chronic physical health problems. The department also uses care managers, who are either mental health nurses, psychologists, or social workers, to help Veterans with mental health issues identify and achieve their health-related goals.
VA researchers’ evaluations of the PC-MHI system have shown that integrated mental health care improves access to high-quality treatment, patient engagement, clinical and functional outcomes, and patient satisfaction. One such study, published in 2018, found that the system provides increased access to mental health care for primary care patients without increasing acute care use for primary care patients. A current project is looking at ways to improve PC-MHI to provide better care for Veterans with depression.
Principal investigator: Dr. Lucinda B. Leung, VA Greater Los Angeles Health Care System
Changing patterns of mental health care use: the role of integrated mental health services in Veteran Affairs primary care. Leung LB, Yoon J, Rubenstein LV, Post EP, Metzger ME, Wells KB, Sugar CA, Escarce JJ. J Am Board Fam Med. 2019 Jan-Feb;31(1):38-48.
Preliminary outcomes from an integrated mental health primary care team. Felker BL, Barnes RF, Greenberg DM, Chaney EF, Shores MM, Gillespie-Gateley L, Buike MK, Morton CE. Psychiatr Serv. 2004 Apr; 55(4):442-4.
A program for teaching psychiatric residents to provide integrated psychiatric and primary medical care. Dobscha SK, Ganzini L. Psychiatr Serv. 2001 Dec;52(12):1651-3.
Integrated medical care for patients with serious psychiatric illness: a randomized trial. Druss BG, Rohrbaugh RM, Levinson CM, Rosenheck RA. Arch Gen Psychiatry. 2001 Sep;58(9):861-8.
Primary Care – Mental Health Integration (PC-MHI), VA Patient Care Services website.
Improving depression management in primary care, NIH RePORTER, project number 1IK2HX002867-01A1.