Locus of Mental Health Treatment in an Integrated Service System

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Abstract
Policy promoted a shift to a primary care model. For veterans with a primary diagnosis of a mental or substance use disorder who made any visit to a VA psychiatric, primary care, or specialty medical clinic, we compared the locus of care and case mix as well as changes in treat- ment patterns during the study period. Results: Of 437,035 veterans treated for a mental disorder during the final six months of the study period, only 7 percent were seen for their mental disorders exclusive- ly in primary care and specialty medical clinics. Compared with veter- ans with mental disorders treated in specialty mental health clinics, those treated in medical clinics had less serious psychiatric diagnoses and made fewer visits. While there was a substantial shift of care from specialty to primary care during the study period, no comparable change in the distribution of care between medical and mental health settings was found. Conclusions: Treatment patterns in VA clinics differ markedly from those in the private sector. Research is needed to de- termine whether and how staffing models developed in HMOs and community samples should be extended to these public-sector settings. (Psychiatric Services 51:890-892, 2000)

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