Primary Care-Mental Health Integration (PC-MHI) is a shared responsibility of the Office of Mental Health Services and the National Primary Care Program.  This web site contains information for the field on integration of mental health in primary care.

Purpose:

The overall purpose of 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.  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.”

History:

One goal of the VA’s Mental Health Strategic Plan is to “develop a collaborative care model for mental health disorders that elevates mental health care to the same level of urgency/intervention as medical health care.” Program funding commenced during fiscal year 2007 after a request for proposals for new programs to promote the effective treatment of common mental health and substance use disorders in the primary care environment.

Plans for full realization of primary care-mental health integration are outlined in the document “Uniform Mental Health Services in VA Medical Centers and Clinics”, issued as VHA Handbook 1160.01 in September 2008.  In short, it delineates structural requirements to promote universal access to mental health services for all Veterans within the scope of primary care practice.  Recommendations for implementation vary based on facility size.  Services for medical centers and large community-based outpatient clinics (CBOCs) are to use a blended integrated care model that includes co-located collaborative care and care management.  Mid-sized to smaller CBOCs are to have an on-site presence of mental health services.  Further details can be obtained in VHA Handbook 1160.01, Uniform Mental Health Services in VA Medical Centers and Clinics.