1125 — Implementation of VHA Primary Care-Mental Health Integration Services: Findings from the 2014 PACT PC-MHI Survey

Brockmann LM, SMITREC, Office of Mental Health Operations; Lasky EC, SMITREC, Office of Mental Health Operations; Mach J, SMITREC, Office of Mental Health Operations; Cornwell BL, SMITREC, Office of Mental Health Operations; McCarthy JF, SMITREC, Office of Mental Health Operations;

Objectives:
Primary Care - Mental Health Integration (PC-MHI) programs are designed to promote effective treatment of mental health conditions commonly occurring among patients in primary care settings. National Veterans Health Administration policies require implementation of PC-MHI programs that include evidence-based components of both care management (CM) and co-located collaborative care (CCC). The National PC-MHI Evaluation conducted the sixth annual national survey to assess program status, characteristics, and presence of CM and CCC at VA medical center (VAMC) divisions and Community Based Outpatients Clinics (CBOCs). This analysis reports Survey findings, describes associations between program components and PC-MHI services utilization, and presents implementation trends.

Methods:
Surveys were completed at all VAMC divisions with Primary Care clinics and all Very Large and Large CBOCs (Very Large: serving 10,000+ patients; Large: serving 5000-9,999 patients; N = 358). CBOC size was determined from fiscal year 2013 Allocation Resource Center data. Web-based Surveys were completed in November-December 2014, with a 100% response rate.

Results:
Nearly all VAMC divisions and Very Large CBOCs, and four-fifths of Large CBOCs, reported having PC-MHI services. Of the 358 divisions surveyed, 93.0% (333) reported having PC-MHI services available for some or all PACT primary care clinics. PC-MHI implementation was most often reported in VAMC divisions. Of all surveyed sites, 90.5% reported CCC, 69.0% CM, and 67.0% reported both CM and CCC. A substantial minority of sites (33.0%) did not report either one or both mandated PC-MHI components (CCC and CM). We provide additional information from the 2014 Survey regarding program characteristics including staffing, supervision, co-location, referral methods, treatment provided, and implementation barriers. We also provide information about how key PC-MHI program implementation and characteristics have changed over time and associations between program component reporting and primary care patients' receipt of PC-MHI services.

Implications:
2014 Survey reports document substantial increases in the availability of PC-MHI services and of both co-located collaborative care and care management over time. However, implementation of care management remains notably incomplete.

Impacts:
Sites should enhance PC-MHI implementation to increase mental health access. In particular, it is important to enhance implementation of evidence-based care management models.