Mental Health Integration into Primary Care

Through the use of primary care-mental health integration (PC-MHI) using team-based primary care models, the Department of Veterans Affairs (VA) in the U.S. attempted to increase access to mental health services starting in 2007. This initiative embedded mental health specialists, including psychologists, counselors, social workers, as well as nurse care managers, into primary care, allowing short, evidence-based treatment. A prior research study shows that a greater usage of an integrated system decreases the use of mental health speciality (MHS) services. Other research shows mixed results when examining PC-MHI’s impact on the usage of mental healthcare in the VA.

In a recent study by Leung and colleagues, researchers were interested in determining which MHS services decreased in usage as a result of implementing PC-MHI, as well as which patients were affected. The first hypothesis was that higher PC-MHI use would be associated with less general MHS appointments and not specialized appointments. The second hypothesis was that patients with depression would have less use of MHS services, due to the use of PC-MHI.

A longitudinal study was performed on a group of 66, 638 patients in Southern California from 2009-2013. Each patient was assigned a home clinic and codes were used to differentiate every mental health appointment as PC-MHI, general MHS, and specialized MHS care. PC-MHI engagement was determined by calculating the number of users and dividing it by the amount of patients per clinic per year. The results were labeled to either go above or below the 2009 (year) baseline. A regression analysis was used to hypothesize the relationship between PC-MHI use and MHS use.

PC-MHI service users were more commonly those with depression, anxiety, and a PTSD diagnoses as opposed to MHS users who were those that had bipolar and schizophrenia. An association was found between greater PC-MHI use and lower general MHS use for patients with depression, however, this was not statistically significant. Hypothesis one and two are shown to be supported by findings. This study shows that by implementing PC-MHI programs, patients have greater access to services which decreases general MHS service use. This is important when considering expanding the use of PC-MHI programs to increase mental health care access to individuals and decrease MHS usage.

---

Source:

• Leung, L.B., Yoon, J., Escarce, J.J., Post, E.P., Wells, K.B., Sugar, C.A,…Rubenstein, L.V. (2018). Primary Care–Mental Health Integration in the VA: Shifting Mental Health Services for Common Mental Illnesses to Primary Care. Psychiatric Services, 69(4), 403-409. Retrieved from: http://dx.doi.org/10.1176/appi.ps.201700190.