Veterans who screen positive for post-traumatic stress disorder (PTSD) who are treated with same-day integrated mental health services within primary care are more likely to receive appropriate diagnosis and treatment, according to research published in Psychiatry Services.
The Veterans Health Administration (VHA) mandates that all veterans be screened for PTSD, but thus far, no system-wide evaluation of the potential impact of primary care-mental health integration (PC-MHI) has been conducted in the VHA. PC-MHI, which began in 2008, includes mental health providers in the same location as primary care providers, allowing them to collaborate and provide disorder-specific care management for psychiatric conditions on the same day that initial need is detected. This care may include prescribing appropriate medications, delivering psychotherapy, and managing referrals to more specialized mental health clinics, including those treating PTSD.
For this study, researchers examined a 30% random sample of all VHA primary care patients in 2010 for a total of 21,427 patients. The sample of patients all had a positive PTSD screen recorded in 2010 and were at least 18 years old.
Of the 21,427 patients, 10,809 (50.4%) received a diagnosis within one year of screening positive. And 41.7% of patients who received PC-MHI services on the date of their positive PTSD screen were also diagnosed as having PTSD on the same day, vs 24.7% for patients who only received primary care services.
After one year, 60.3% of patients who screened positive for PTSD had received a diagnosis, compared with 47.9% for those who only received primary care.
The researchers note that although PTSD screening is mandated within the VHA, efforts to care for patients with PTSD will be suboptimal without proper follow-up.
“Study findings indicate that same-day integrated mental health services within primary care may increase the likelihood of PTSD diagnosis and treatment,” wrote Kipling Bohnert, PhD, from the University of Michigan Health System. “When patients screen positive for PTSD, primary care providers should consider engaging integrated mental health services to help facilitate diagnostic assessment and treatment initiation.”
Bohnert K et al. Same-Day Integrated Mental Health Care and PTSD Diagnosis and Treatment Among VHA Primary Care Patients With Positive PTSD Screens. Psychiatry Services. 2015; doi:10.1176/appi.ps.2015000035.