title: Mental health care treatment initiation when mental health services are incorporated into primary care practice.
abstract: OBJECTIVE
  Most primary care patients with mental health issues are identified or treated in primary care rather than the specialty mental health system. Primary care physicians report that their patients do not have access to needed mental health care. When referrals are made to the specialty behavioral or mental health care system, rates of patients who initiate treatment are low. Collaborative care models, with mental health clinicians as part of the primary care medical staff, have been suggested as an alternative. The aim of this study is to examine rates of treatment startup in 2 collaborative care settings: a rural family medicine office and a suburban internal medicine office. In both practices referrals for mental health services are made within the practice.
  
  
  METHODS
  Referral data were drawn from 2 convenience samples of patients referred by primary care physicians for collaborative mental health treatment at Fletcher Allen Health Care in Vermont. The first sample consisted of 93 consecutively scheduled referrals in a family medicine office (sample A) between January 2006 and December 2007. The second sample consisted of 215 consecutive scheduled referrals at an internal medicine office (sample B) between January 2009 and December 2009. Referral data identified age, sex, and presenting mental health/medical problem.
  
  
  RESULTS
  In sample A, 95.5% of those patients scheduling appointments began behavioral health treatment; in sample B this percentage was 82%. In sample B, 69% of all patients initially referred for mental health care both scheduled and initiated treatment.
  
  
  CONCLUSIONS
  When referred to a mental health clinician who provides on-site access as part of a primary care mental health collaborative care model, a high percentage of patients referred scheduled care. Furthermore, of those who scheduled care, a high percentage of patients attend the scheduled appointment. Findings persist despite differences in practice type, populations, locations, and time frames of data collection. That the findings persist across the different offices suggests that this model of care may contain elements that improve the longstanding problem of poor treatment initiation rates when primary care physicians refer patients for outpatient behavioral health services.
authors.affiliation: Department of Family Medicine, University of Vermont College of Medicine, Burlington, VT, USA. Rodger.Kessler@uvm.edu
authors.forename: Rodger
authors.initials: R
authors.lastname: Kessler
mesh_terms: D000328:Adult; D015897:Comorbidity; D003299:Cooperative Behavior; D005194:Family Practice / Q000458:organization & administration; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007388:Internal Medicine / Q000458:organization & administration; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation; D008605:Mental Health Services / Q000458:organization & administration*; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration; D019035:Rural Health Services / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000534:rehabilitation; D019036:Suburban Health Services / Q000458:organization & administration*; D014707:Vermont