A Warm Hand Off from Primary Care to Mental Health Makes All the Difference in the Primary Care Mental Health Integration (PC-MHI) Program
The Primary Care - Mental Health Integration (PC-MHI) Program provides fast and convenient care by putting mental health-trained staff into the primary care setting, making the process of asking and getting help easy for Veterans.
This process involves coordinating same-day access to mental health care by facilitating a warm handoff from primary care to PC-MHI during a primary care visit.
Additionally, primary care providers at VA screen all Veterans for mental health, including depression, PTSD, and suicide, and if needed, connect Veterans to a PC-MHI mental health provider, all in the same visit. Mindful that there is a still a perceived stigma around mental health in some parts of the community, clinicians employ compassionate and comprehensive screening tactics.
“These are routine things that we ask anybody, even if they don’t identify as being higher risk. We’re normalizing things by saying, ‘Anybody who we are taking care of, we are going to ask these important questions,’” said Dr. Lucinda Leung, Primary Care Physician and Researcher at VA Greater Los Angeles Healthcare System (VAGLAHS).
If the screening indicates that a Veteran can benefit from talking to a PC-MHI mental health provider, it can be as easy as walking a Veteran down the hall at the West Los Angeles VA Medical Center, where primary and mental health care teams physically share the same space.
“When the physical barrier is reduced and we can just walk down the hallway to meet with the Veteran or they can be brought to our office, even if they are just open to speaking with mental health for a few minutes, we are there to catch it,” said Dr. Suzie Chen, Clinical Psychologist and Deputy Chief for the PC-MHI Program at VAGLAHS.
PC-MHI providers are also physically located at Los Angeles Ambulatory Care Center, Sepulveda Ambulatory Care Center, San Gabriel Valley VA Clinic, Antelope Valley VA Clinic, Santa Maria VA Clinic, and San Luis Obispo VA Clinic depending on their availability. If one isn’t available on-site that day, telehealth provides easy and quick access to mental health care for Veterans in primary care.
“Telehealth has been something that VA Research has been studying for decades. Research has shown that it can help with increasing access to Veterans that are in rural areas, that are harder to reach, or have other transportation barriers or physical barriers that prevents them from physically coming into the clinic,” said Leung.
Quick access, for both in-person and telehealth services, plays a significant role in prevention. Phone and video calls are available to make mental health care more accessible and convenient for Veterans, and a warm hand-off addresses the Veterans’ concerns the same day.
According to this 2008 study, “Improving efficiency and access to mental health care: combining integrated care and advanced access,” by researchers Drs. Andrew Pomerantz, Brady Cole, Bradley Watts and William Weeks, the PC-MHI Program also reduced the wait times for mental health treatment from referrals by treating Veterans in a primary care setting,
When a Veteran is waiting for a mental health care appointment from a referral, sometimes that motivation or interest in getting help may change, said Chen.
“Often, we are able to address a concern before it gets to a more clinically significant level, before it becomes more severe. And we can plant that seed, right? Even if they’re not ready to meet for a full mental health visit at that moment, they’ve met a friendly face. We’ve spoken for five minutes and introduced ourselves, so the next time around, the barrier [to seeking mental health care] is often lower. Hopefully, the Veteran will be less guarded about reaching out for mental health care in the future,” said Chen.
Improving access and treating the whole person, including their mental health in the primary care setting, has shown to improve management of physical health conditions, according to the 2002 study, “Association of Integrated Mental Health Services with Physical Health Quality Among VA Primary Care Patients,” by researchers Drs. Lucinda Leung, Lisa Rubenstein, Erin Jaske, Leslie Taylor, Edward Post, Karin Nelson, and Ann-Marie Rosland.
Additionally, same-day integrated mental health services within primary care were associated with greater odds of PTSD diagnosis and treatment according to the 2015 study, “Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patient with Positive PTSD Screens,” by VA researchers Drs. Kipling Bohnert, Rebecca Sripada, Jennifer Mach, and John McCarthy.
“We’ve worked really hard to build relationships with our primary care teams,” said Chen. “This allows us to look at each Veteran holistically to say, ‘Are there also other factors, such as medications or medical conditions that may be impacting their mental health and vice versa?’”
This close collaboration between mental health and primary care allows Veterans to receive the highest quality care that they have earned and deserve.
For Veterans looking to schedule an appointment with primary care, please reach out to the 24/7 VA Greater Los Angeles Healthcare System Administrative Call Center at 877-251-7295.
If you are a Veteran in crisis or concerned about one, the 24/7 Veterans Crisis Line has caring and qualified responders available to listen and help, free for Veterans and their loved ones. You don’t have to be enrolled in VA benefits to connect with the Veterans Crisis Line. Dial 988, press 1 for Veterans or text 838255 or chat with responders at VeteransCrisisLine.net/Get-Help-Now/Chat.