VHA Whole Health Services and Complementary and Integrative Health Therapies: a Gateway to Evidence-Based Mental Health Treatment.

BACKGROUND: Engagement in evidence-based psychotherapy (EBP) among veterans with behavioral health conditions is often low. The Veterans Health Administration (VHA) is implementing a "Whole Health (WH)" system of care, to identify veteran personal health goals, align care with those goals, and offer services designed to engage and empower veterans to achieve well-being. OBJECTIVE: To examine the relationship between veteran WH utilization and subsequent engagement in EBP. DESIGN: Retrospective analysis of VHA administrative records from 18 facilities implementing WH. SUBJECTS: Veterans (n = 265,364) with a diagnosis of depression, post-traumatic stress disorder (PTSD), and/or anxiety who had a mental healthcare encounter but no EBP use in fiscal year (FY) 2018. Among this cohort, 33,146 (12.5%) began using WH in FY2019. MAIN MEASURES: We examined use of an EBP for depression, anxiety, and/or PTSD within 1 year of the index date of WH use compared to use of an EBP anytime during FY2019 for veterans not identified as using WH. We used multiple logistic regression to examine the association between veteran WH use and EBP engagement. KEY RESULTS: Approximately 3.0% (n = 7,860) of the veterans in our overall cohort engaged in an EBP in the year following their index date. Controlling for key demographic, health, and utilization variables, WH users had 2.4 (95% CI: 2.2-2.5) times higher odds of engaging in an EBP the following year than those with no WH utilization. Associations between utilization of specific WH services (vs. no utilization of that service) and engagement in an EBP in the subsequent year ranged from 1.6 (95% CI: 1.0-2.6) to 3.5 (95% CI: 3.2-3.9) across the different types of WH services used. CONCLUSIONS: WH use was associated with increased engagement in EBPs among veterans with depression, anxiety, and/or PTSD. Future interventions intended to promote veteran engagement in EBPs may benefit from leveraging WH services and therapies.

Influence of Provider Gender on Mental Health Stigma.

This study examined gender differences in mental health providers' stigma toward people with mental illness. As part of a larger professional education needs assessment at a VA healthcare system, 77 mental health providers of various disciplines completed a self-report measure of stigma towards people with various mental health diagnoses. Results indicated that male mental health providers hold significantly more stigmatizing views toward people with schizophrenia and posttraumatic stress disorder (PTSD), which is consistent with provider gender differences found in other areas of study and theories of stigma and masculinity. These results can be used to build on stigma reduction interventions. Future research should continue to examine the underlying reasons for gender differences among providers.

Psychologist and Physician Inter-Professional Collaborative Experiences in Primary Care Integration.

In recent years, the subject of integrated healthcare, including the integration of behavioral health services into primary care, within the healthcare field has been increasingly of interest to researchers, providers, and policy makers. However, little is known about the experiences of providers within integrated care and the impact of these experiences on inter-professional relationships and collaboration. The researchers aimed to explore differences in providers' perspectives, including inter-professional collaboration and overall job satisfaction, by provider type and level of integration. The current study uses a mixed method exploratory approach, gathering both qualitative and quantitative data to investigate the perspectives of providers (both psychologists and physicians) on their work together. This study included 30 psychologists and 30 primary care physicians from three levels of healthcare integration (traditional/coordinated, co-located, and integrated). As hypothesized, results indicated that providers in integrated settings were the most satisfied with their collaboration with other providers. Furthermore, the providers' narratives revealed promising insights which contribute to a broader understanding of how to improve the relationships between psychologists and primary care physicians in integrated healthcare and other settings.