Home-Based Primary Care-Mental Health Integration in the Veterans Health Administration: An Updated Evaluation of Practice Patterns

• Published in: Psychological services 2023-11, Vol.20 (4), p.723-733
• Main Authors: Mavandadi, Shahrzad, Wetherell, Julie Loebach, Barker, Marie D., Steadman-Wood, Pamela L., Harrington, Paula J., Karel, Michele J.
• Format: Article
• Language: English
• Subjects: Access; Aged; Data; Government Agencies; Health behavior; Health Care Administration; Health education; Health services; Health status; Home based; Home Care; Home Care Services; Human; Humans; Integrated care; Integrated Services; Mental Health; Mental health care; Mental Health Services; Military hospitals; Military Veterans; Needs; Polls & surveys; Primary care; Primary Health Care; Responses; Staffing; Teams; Training; Training needs; United States; United States Department of Veterans Affairs; Veterans; Veterans - psychology; Veterans Health; Workforce planning
• ISSN: 1541-1559; 1939-148X; 1939-148X
• DOI: 10.1037/ser0000710

Starting in 2008, the U.S. Veterans Health Administration required the integration of mental health providers (MH providers) in Home-Based Primary Care (HBPC) programs to promote access to and quality of mental health services for veterans enrolled in HBPC. Surveys were administered in both 2010 and 2019 to HBPC program directors and MH providers to evaluate the status of mental health practice in HBPC programs and inform the continued development of program resources. Findings reported here summarize responses to the 2019 survey and highlight changes compared to 2010 in key areas (e.g., mental health staffing and workload, services provided, training needs, and integration with and impact on the HBPC team). In 2019, approximately half of invited HBPC program directors (n = 66) and MH providers (n = 136) completed the voluntary, anonymous, and confidential surveys. Descriptive and bivariate analyses of quantitative data, and thematic analyses of open-text responses, were conducted. Comparisons of survey responses were made between the 2019 surveys and those collected in 2010 from MH providers (n = 132) and program directors (n = 112), and indicated similar patterns of variability in program staffing and practices across sites, with ongoing behavioral/mental health education and training needs reported for both MH providers and teams. The perceived degree and value of mental health integration in HBPC also remained high. Survey responses suggest integration of mental health services into HBPC continues to be feasible and improves access to key services. Findings may inform the expansion of home-based mental health services for meeting the needs of an aging population. Impact Statement Integrated mental health services in Veterans Health Administration Home-Based Primary Care (HBPC) programs remain strongly valued, and with variable practice patterns, according to HBPC program directors and mental health providers surveyed in both 2019 and 2010. This operational feedback will guide ongoing development of HBPC mental health program resources and may inform expansion of home-based mental health services for an aging population.