title: The provision of mental health treatment after screening: exploring the relationship between treatment setting and treatment intensity.
abstract: OBJECTIVE
  Primary care screening programs for mental health disorders are designed to detect patients who might benefit from treatment. As such, the utility of these programs is predicated on the actions that take place in response to a positive screen. Our objective was to characterize the cascade of care delivery steps following a positive screen for a mental health disorder.
  
  
  METHODS
  We examined the care received by primary care patients over the year following a new positive screen for depression, posttraumatic stress disorder (PTSD) or alcohol misuse. We characterized whether the care adhered to practice guidelines for related mental health disorders and whether involvement of mental health specialists led to higher use of guideline-adherent practices.
  
  
  RESULTS
  Many patients received appropriate treatment in the primary care setting and those whose scores were consistent with more severe illness were more likely to receive care in a mental health setting. Patients with positive screens for depression and PTSD who went on to be seen in mental health clinics received care that was consistent with treatment guidelines for the related disorder most of the time. In the case of patients with positive screens for alcohol misuse, few received guideline-recommended medications in any setting. However, a substantial portion of patients received some alcohol-related counseling from their primary care physicians during the visit in which their alcohol misuse was detected.
  
  
  CONCLUSIONS
  It appears that the treatment system for mental health problems, which extends from primary care settings to mental health subspecialty settings, can provide adequate care when patients' mental health problems are identified through screening. The care provided in all settings can be improved, and additional steps to enhance the quality of care are warranted. This should include additional efforts to align screening and treatment.
authors.affiliation: Veterans Affairs Medical Center, White River Junction VT, USA; National Center for Patient Safety Field Office, White River Junction VT, USA; New England Veterans Engineering Resource Center, Boston MA, USA; Geisel School of Medicine at Dartmouth, Hanover NH, USA. Electronic address: brian.shiner@va.gov.
authors.forename: Brian
authors.initials: B
authors.lastname: Shiner
authors.affiliation: Worcester Polytechnic Institute, Worchester MA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Tang
authors.affiliation: New England Veterans Engineering Resource Center, Boston MA, USA; Worcester Polytechnic Institute, Worchester MA, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Trapp
authors.affiliation: New England Veterans Engineering Resource Center, Boston MA, USA; Worcester Polytechnic Institute, Worchester MA, USA.
authors.forename: Renata
authors.initials: R
authors.lastname: Konrad
authors.affiliation: New England Veterans Engineering Resource Center, Boston MA, USA; Worcester Polytechnic Institute, Worchester MA, USA.
authors.forename: Isa
authors.initials: I
authors.lastname: Bar-On
authors.affiliation: Veterans Affairs Medical Center, White River Junction VT, USA; National Center for Patient Safety Field Office, White River Junction VT, USA; New England Veterans Engineering Resource Center, Boston MA, USA; Geisel School of Medicine at Dartmouth, Hanover NH, USA.
authors.forename: Bradley V
authors.initials: BV
authors.lastname: Watts
mesh_terms: D000437:Alcoholism / Q000175:diagnosis / Q000628:therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy; D019983:Guideline Adherence; D006297:Health Services Accessibility; D006801:Humans; D008403:Mass Screening; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008605:Mental Health Services; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012017:Referral and Consultation / Q000592:standards*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000628:therapy; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology
chemical_list: D011619:Psychotropic Drugs
keywords: Access; Mental health; Primary care; Screening