VA and Dod are innovating to improve primary care for soldiers and veterans with mental disorders: Research and implementation efforts

Engle CC, Williams JW, Magruder KM, Kirchner JE, Schnurr PP. VA and Dod are innovating to improve primary care for soldiers and veterans with mental disorders: Research and implementation efforts. Paper presented at: VA HSR&D National Meeting; 2007 Feb 23; Arlington, VA.

Related HSR&D Project(s)

• MNT 02-209 – Cost & Value of Evidence Based Solutions for Depression (COVES)

Workshop Objectives: Psychiatric disorders and symptoms following military deployments and war are common. Research suggests the prevalence of Posttraumatic Stress Disorder (PTSD), Major Depression, and related problems are high among those returning from the conflicts in Afghanistan and Iraq. Less than a fourth with significant disorders report receiving specialty mental health care in the past year, reflecting important factors related to stigma and structural barriers to accessing specialty care. Many service members and veterans with mental health treatment needs may prefer care from their usual primary care provider rather than a specialist. Relatively scarce mental health resources may also be a limiting factor. For their part, many primary care providers are motivated to provide mental health care, but time limitations, perceived scope of practice, lack of confidence in treating these disorders, and an insufficient systematic clinical infrastructure to support primary care-based mental health service delivery may deter them. To address this challenge, investigators have developed primary care treatment models for depression and PTSD that: prepare the primary care practice setting, add a case-management resource, and enhance the primary care-specialty care interface. Both the VA and DoD health care systems are completing research evaluating these approaches and are preparing to launch major implementation efforts. This workshop will review the research regarding the mental health needs of veterans and service members returning from ongoing conflicts and describe new research and related program implementation efforts. Presentations will also address VA and DoD activities at the health policy leadership and research level, activities attempting to optimally meet the mental health needs of those who have served the nation in war and deployment. Activities: The authors will present on (1) Evidence related to the mental health needs of military personnel and of veterans receiving care in VA primary care setting; (2) Primary care-based mental health treatment models with applicability to veterans and service members; (3) Perspectives of health policy leaders regarding implementation of these models; and (4) staged US Army implementation of a primary care model (“RESPECT-MIL) designed to improve depression and PTSD care in military personnel. Target Audience: Primary care and mental health clinicians and health services researchers. Assumed Audience Familiarity with Topic: The workshop seeks a broad multidisciplinary audience of methodologists and clinicians, not necessarily only those currently working in the field.