Treating Complex Mental Health Conditions in Primary Care
A CoCM program will need to be adapted to effectively treat patients with bipolar disorder and/or post traumatic stress disorder (PTSD). The Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT) piloted adaptations to CoCM based on careful study of CoCM principles as well as the evidence base for the screening, assessment and treatment of bipolar disorder and PTSD. SPIRIT successfully demonstrated that the treatment of bipolar disorder and/or PTSD with Collaborative Care (CoCM) in primary care is just as effective as treatment in specialty mental health care.
Primary Care Advantage
SPIRIT provides compelling evidence that complex mental health conditions do not require referral to specialty mental health care and can be effectively treated in primary care with CoCM.
- Only 33% of individuals with bipolar disorder and PTSD recieve specialty mental health care in a given year. CoCM provides direct access to the specialty psychiatric care necesarry to treat these conditions.
- CoCM requires significantly less psychiatric provider time than treatment in routine specialty care, optimizing the use of a scarce treatment resource.
- CoCM increases coordination of physical health and mental health care. In addition, lab services for monitoring some medications are more easily accessed in primary care.
A core principle of CoCM is measurement-based treatment to target. This means, in part, that screening tools are used to help identify behavioral health conditions and monitoring tools are used to track how a patient’s symptoms respond to treatment over time. Without systematic screening in primary care, PTSD usually goes undetected, with only 11% to 18% of primary care patients meeting clinical criteria for PTSD having a documented diagnosis. Find clinical measures for bipolar disorder or Post Traumatic Stress Disorder (PTSD) used in SPIRIT below.
- Alcohol use screening: AUDIT (Alcohol Use Disorders Identification Test)
- Alcohol use symptom monitoring: AUDIT-C (Alcohol Use Disorders Identification Tool – Concise)
- Anxiety screening & symptom monitoring: GAD-7 (Generalized Anxiety Disorder)
- Bipolar disorder screening: CIDI-based Screening Scale for Bipolar Disorder
- Bipolar disorder mania symptom monitoring: PMQ-9 (Patient Mania Questionnaire)
- Bipolar disorder mania symptom monitoring (Spanish): PMQ-9 (Patient Mania Questionnaire) Spanish
- Bipolar disorder depression symptom monitoring: PHQ-9 (Patient Health Questionnaire)
- Depression screening & symptom monitoring: PHQ-9 (Patient Health Questionnaire)
- PTSD screening & symptom monitoring: PCL-5 (PTSD Checklist for DSM-5)