Continuation of care following an initial primary care visit with a mental health diagnosis: differences by receipt of VHA Primary Care-Mental Health Integration services.
N C Med J January/February 2008, Volume 69, Number 1 he Veterans Health Administration has undertaken a large national initiative to integrate primary care and mental health services. A request for proposals was disseminated throughout the Veterans Affairs (VA) system inviting proposals for new programs to promote the effective treatment of common mental health and substance use disorders in the primary care environment. Both individual facilities and Veterans Integrated Service Networks (VISNs) were eligible to apply, and proposals could encompass activities at one or multiple VA facilities. Similarly, facilities within VISNs were free to use different evidence-based models for delivering integrated care. Program funding commenced during fiscal year 2007 (FY07). The overarching rationale for the initiative is to integrate care for veterans’ physical and mental health conditions, improve access and quality of care across the spectrum of illness severity, and allow treatment in mental health specialty settings to focus on persons with more severe mental illnesses. The report of the President’s New Freedom Commission on Mental Health emphasizes that mental health and physical health problems are interrelated components of overall health and are best treated in a coordinated care system. That recognition also is embedded in the VA’s Mental Health Strategic Plan and its goal to “[d]evelop a collaborative care model for mental health disorders that elevates mental health care to the same level of urgency/intervention as medical health care.” The important context of integrated care recognizes several facts: primary care provides opportunities to screen for unrecognized disease; mental health and substance abuse conditions are common and are often treated by primary care practitioners; patients may prefer treatment in primary care settings; an established relationship with a primary care practitioner fosters engagement in and adherence to treatment; and health conditions do not always fall neatly into “physical” and “mental health” categories. As former Surgeon General David Satcher said, “Primary care practitioners are a critical link in identifying and addressing mental disorders... Opportunities are missed to improve mental health and general medical outcomes when a mental illness is under-recognized and under-treated in primary care settings.”