Table 1 Summary of participants’ concerns and recommendations on integrating mental health services into primary care
Concerns | Recommendations |
|---|---|
Integration of counselors into the primary care clinic | |
1. Workplace hierarchies | 1. Train current PCPs as counselora |
2. Lack of true collaboration between counselor and PCP | 2. Co-manage patients between PCPs and counselors |
3. Current clinic space may not provide privacy for counselor encounters | 3. Create private space for mental health evaluations |
4. Staff turnover and continuity of care | 4. Recruit a senior and a junior counselor. If the senior person cannot be retained, the junior counselor will have received mentorship. 5. Use manualized therapy so a new counselor can take over care using the same principles of treatment. |
5. High patient load for counselor | 6. Consider group therapy rather than one-on-one therapy. |
Consultation from an off-site psychiatrist | |
6. Reliability of off-site psychiatrist | 7. Prioritize recruiting academic psychiatrists, who may have a flexible schedule and be reliable. |
7. High number of patients for case review | 8. Discuss amongst on-site clinicians first to decide which patients to discuss 9. Develop a priority order (e.g. by severity) and discuss those patients first, rather than trying to discuss all patients. |
8. Consultation questions may not wait until the weekly review meeting | 10. Allow urgent consultation throughout the week, in coordination with the PCP and counselor. |
Training and Support for PCPs | |
9. PCPs may not be able to appropriately screen patients for mental illness | 11. Train and support PCPs in screening, diagnosis and treatment of mental illness 12. Integrate screening tools into the medical records system |
10. PCPs may not have the requisite clinical skills to follow the psychiatrist’s recommendations | 13. Provide on-site training on clinical skills by a visiting psychiatrist |
11. Risk of abuse of psychiatric medications. | 14. (No recommendation) |