title: Developing effective collaboration between primary care and mental health providers.
abstract: OBJECTIVE
  Improving care for depressed primary care (PC) patients requires system-level interventions based on chronic illness management with collaboration among primary care providers (PCPs) and mental health providers (MHPs). We describe the development of an effective collaboration system for an ongoing multisite Department of Veterans Affairs (VA) study evaluating a multifaceted program to improve management of major depression in PC practices.
  
  
  METHODS
  Translating Initiatives for Depression into Effective Solutions (TIDES) is a research project that helps VA facilities adopt depression care improvements for PC patients with depression. A regional telephone-based depression care management program used Depression Case Managers (DCMs) supervised by MHPs to assist PCPs with patient management. The Collaborative Care Workgroup (CWG) was created to facilitate collaboration between PCPs, MHPs, and DCMs. The CWG used a 3-phase process: (1) identify barriers to better depression treatment, (2) identify target problems and solutions, and (3) institutionalize ongoing problem detection and solution through new policies and procedures.
  
  
  RESULTS
  The CWG overcame barriers that exist between PCPs and MHPs, leading to high rates of the following: patients with depression being followed by PCPs (82%), referred PC patients with depression keeping their appointments with MHPs (88%), and PC patients with depression receiving antidepressants (76%). The CWG helped sites implement site-specific protocols for addressing patients with suicidal ideation.
  
  
  CONCLUSIONS
  By applying these steps in PC practices, collaboration between PCPs and MHPs has been improved and maintained. These steps offer a guide to improving collaborative care to manage depression or other chronic disorders within PC clinics.
authors.affiliation: Mental Health Service, Department of Veterans Affairs, VA Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: Bradford L
authors.initials: BL
authors.lastname: Felker
authors.forename: Edmund
authors.initials: E
authors.lastname: Chaney
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.forename: Laura M
authors.initials: LM
authors.lastname: Bonner
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.forename: Louise E
authors.initials: LE
authors.lastname: Parker
authors.forename: Linda L M
authors.initials: LL
authors.lastname: Worley
authors.forename: Scott E
authors.initials: SE
authors.lastname: Sherman
authors.forename: Scott
authors.initials: S
authors.lastname: Ober