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VA Ann Arbor Healthcare System


Primary Care Mental Health Integration


Team-based approach.

By Dr. Elizabeth Imbesi
Tuesday, December 22, 2015

Primary Care – Mental Health Integration (PCMHI) Arrives at the

VA Toledo Community Based Outpatient Clinic (CBOC)


If you have Diabetes, you go to your primary care provider.

If you have Depression, you go to your mental health provider.

Seems simple, right? Well, it would be... if only people actually were split between their brains and their bodies.  Not to mention the stigma that still hangs about the concept of mental health, preventing people from accessing needed care.

Fortunately, in recent years, medical professionals have paid increasing attention to the important and close link between physical and mental health. The relationship between diabetes and depression is a good example.  People with diabetes are twice as likely to have depression as people without diabetes. And depression can strongly influence how patients take care of their diet, exercise and bodies. 

Diabetes is only one of countless medical conditions that can be profoundly affected by mental health. Therefore, it makes sense to address both at the same visit – not to mention the added convenience: no need to make two appointments or to drive to the clinic twice.

What about stigma? Back when I was a psychology doctoral intern, a Veteran I encountered summed it up nicely: “We don’t push the button to the tenth floor (where mental health clinics were located). We hit the ninth floor button, or the eleventh floor, and walk up or down a flight so no one knows where we’re going.” He explained further that meeting me in primary care on the first floor gave him the opportunity to be anonymous about the nature of his care. No one in the wait area or hallways had any idea why he was in clinic that day, and he liked that.

Primary Care – Mental Health Integration (PCMHI) locates mental health services conveniently in primary care to address Veterans’ needs with a holistic advantage. When primary care providers recognize that a Veteran has a mental health concern, they collaborate with PCMHI providers who are located within those clinics. PCMHI providers then see the patient for a brief assessment and treatment planning. Thus, many mental health concerns are addressed in primary care, with brief, targeted therapies. Primary care and PCMHI providers work together to care for Veterans using a team based approach, providing Veterans with a seamless care experience.

This concept is fairly new, but early evidence suggests that those who first encounter mental health services in primary care – a more convenient, less stressful approach – are more than twice as likely to continue treatment, or seek additional services. Veterans who’ve experienced PCMHI often state that they feel freer to express thoughts and emotions that they have never talked about to anyone before.

As for the VA Ann Arbor Healthcare System (VAAAHS)? PCMHI has recently been introduced to VAAAHS’s VA Toledo Community Based Outpatient Clinic with a team that consists of Dr. Elizabeth Imbesi, PhD (author), and Mr. Steven Beverly, LMSW.  The program is growing quickly since it was implemented in March of 2015, with the support of primary care staff, mental health clinic staff including Dr. Amy Bixler, Program Manager of Mental Health Services at the Toledo CBOC, and executive leadership including Dr. Thomas Gross, Director of the Toledo CBOC. 

As for convenience? Veterans are often pleasantly surprised to be seen in primary care for their mental health needs on the same day as their other appointments.  Many report that they find it to be far less intimidating than they thought it would be, and quite often they are surprised to learn that their mental health concerns are related to and affect their physical health and vice versa.

And for the Veteran I encountered during my internship? Once he experienced the concept of mental health treatment through its introduction in primary care, he actually became an outreach ambassador for PTSD treatment among OEF/OIF combat Veterans.

The VAAAHS PCMHI Team is committed to providing the best care possible to those who have served our country. We can be reached at x56212 (Dr. Imbesi) or x57586 (Mr. Beverly)  and are always happy to talk with Veterans, providers, or anyone else who wants to learn more about Primary Care – Mental Health Integration at the Toledo CBOC. 


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