Advertisement

Integrating Mental Health and Primary Care Services in the Department of Veterans Affairs Health Care System

  • Antonette M. ZeissEmail author
  • Bradley E. Karlin
Article

Abstract

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation’s largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA’s efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients.

Keywords

Primary care Mental health Veteran's Affairs 

References

  1. Areán, P. A., Alvidrez, J., Barrera, A., Robinson, G. S., & Hicks, S. (2002). Would older medical patients use psychological services? Gerontologist, 42, 392–398.PubMedGoogle Scholar
  2. Bartels, S. J., Coakley, E. H., Zubritsky, C., Ware, J. H., Miles, K. M., Areán, P. A., et al. (2004). Improving access to geriatric mental health services: A randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. American Journal of Psychiatry, 161, 1455–1462.PubMedCrossRefGoogle Scholar
  3. Chen, H., Coakley, E. H., Cheal, K., Maxwell, J., Costantino, G., Krahn, D. D., et al. (2006). Satisfaction with mental health services in older primary care patients. American Journal of Geriatric Psychiatry, 14, 371–379.PubMedCrossRefGoogle Scholar
  4. Felker, B. L., Chaney, E., Rubenstein, L. V., Bonner, L. M., Yano, E. M., Parker, L. E., et al. (2006). Developing effective collaboration between primary care and mental health providers. Primary Care Companion to the Journal of Clinical Psychiatry, 8, 12–16.PubMedGoogle Scholar
  5. Hedrick, S. C., Chaney, E. F., Felker, B., Liu, C., Hasenberg, N., Heagerty, P., et al. (2003). Effectiveness of collaborative care depression treatment in Veterans’ Affairs primary care. Journal of Internal Medicine, 18, 9–16.Google Scholar
  6. Karlin, B. E., & Fuller, J. D. (2007). Geriatric mental health service use and treatment outcomes: Implications for primary care practice. Geriatrics, 62, 26–35.PubMedGoogle Scholar
  7. Katon, W., Von Korff, M., Lin, E., Simon, G., Walker, E., Unutzer, J., et al. (1999). Stepped collaborative care for primary care patients with persistent symptoms of depression: A randomized trial. Archives of General Psychiatry, 56, 1109–1115.PubMedCrossRefGoogle Scholar
  8. Katon, W., Russo, J., Von Korff, M., Lin, E., Simon, G., Bush, T., et al. (2002). Long-term effects of a collaborative care intervention in persistently depressed primary care patients. Journal of Geriatric Internal Medicine, 17, 741–748.CrossRefGoogle Scholar
  9. Longman, P. (2007). Best care anywhere: Why VA health care is better than yours. Sausalito: PoliPoint Press.Google Scholar
  10. Liu, C. F., Cedrick, S. C., Chaney, E. F., Heagerty, P., Felker, B., Hasenberg, N., et al. (2003). Cost effectiveness of collaborative care for depression in a primary care veteran population. Psychiatric Services, 54, 698–704.PubMedCrossRefGoogle Scholar
  11. Oslin, D. W., Ross, J., Sayers, S., Murphy, J., Kane, V., & Katz, I. R. (2006). Screening, assessment, and management of depression in VA primary care clinics. The behavioral health laboratory. Journal of General Internal Medicine, 21, 46–50.PubMedCrossRefGoogle Scholar
  12. Pignone, M. P., Gaynes, B. N., Rushton, J. L., Burchell, C. M., Orleans, C. T., Mulrow, C. D., et al. (2002). Screening for depression in adults: A summary of the evidence for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 136, 765–76.PubMedGoogle Scholar
  13. Rollman, B. L., Belnap, B. H., Mazumdar, S., Houck, P. R., Zhu, F., Gardner, W., et al. (2005). A randomized trial to improve the quality of treatment for panic and generalized anxiety disorders in primary care. Archives of General Psychiatry, 62, 1332–1341.PubMedCrossRefGoogle Scholar
  14. Roy-Byrne, P. B., Katon, W., Cowley, D. S., & Russo, J. (2001). A randomized effectiveness trial of collaborative care for patients with panic disorder in primary care. Archives of General Psychiatry, 58, 869–876.PubMedCrossRefGoogle Scholar
  15. Skultety, K. M., & Zeiss, A. M. (2006). The treatment of depression in older adults in the primary care setting: An evidence-based review. Health Psychology, 25, 665–674.PubMedCrossRefGoogle Scholar
  16. Speer, D. C., & Schneider, M. G. (2003). Mental health needs of older adults and primary care: Opportunity for interdisciplinary geriatric team practice. Clinical Psychology: Science and Practice, 21, 85–101.CrossRefGoogle Scholar
  17. Tai-Seale, M., Bramson, R., Drukker, D., Hurwicz, M. L., Ory, M., Tai-Seale, T., et al. (2005). Understanding primary care physicians’ propensity to assess elderly patients for depression using interaction and survey data. Medical Care, 43, 1217–1224.PubMedCrossRefGoogle Scholar
  18. Unützer, J., Katon, W., Callahan, C. M., Williams, J. W., Hunkeler, E., Harpole, L., et al. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. Journal of the American Medical Association, 288, 2836–2845.PubMedCrossRefGoogle Scholar

Copyright information

© U.S. Government 2008

Authors and Affiliations

  1. 1.Department of Veterans Affairs Central OfficeWashingtonUSA

Personalised recommendations