Mental Health Integration — Integrated Care Components
Co-located Collaborative Care:
Co-located collaborative care entails both mental health and primary care practitioners being physically present in the primary care setting with shared responsibility for evaluation, treatment planning, and monitoring outcomes. A particular example of co-located collaborative care in VA is at the White River Junction VAMC, where there is open access mental health treatment in primary care. This model has demonstrated significant increases in both the proportion of depression screen-positive patients receiving any treatment as well as the proportion of patients receiving guideline-concordant treatment for depression (Watts, et al, 2007).
Care management components need not be physically located in the primary care setting, but care managers are actively involved in the process of delivering mental health treatment to primary care patients. Nurses constitute a core profession in care management, although social workers and psychologists also perform the role of mental health care manager. Care managers interact directly with patients, facilitate ongoing evaluation, and maintain active communication that enables responsibility for mental health treatment to remain in the primary care setting.
Two examples of care management components in VA are Translating Initiatives for Depression into Effective Solutions (TIDES) and the Behavioral Health Laboratory (BHL). The TIDES care management component uses registered nurses to provide guideline-based treatment support and has demonstrated high levels of treatment engagement among depressed primary care patients (Felker, et al, 2006). The BHL uses a software-based structured assessment for initial evaluation as well as on demand follow-up in support of primary care-based treatment, including significant increases in patients identified with depresssion, substance misuse, and other mental health co-morbidities (Oslin, et al, 2006).
Blended programs combine elements of both care management and co-located collaborative care. In a blended program, the mental health practitioner evaluates patients and offers psychosocial treatment when preferred or needed while the care manager provides complementary services including education, ongoing assessment, monitoring of adherence, algorithm-based use of medication, and referral management when necessary.