Integrating mental health services into a HIV/AIDS primary care setting: Co-location is only the beginning

Issues: Health professionals and researchers have described psychological and psychosocial sequelae associated with HIV/AIDS, presenting as distress, anger, guilt, bereavement, and other psychiatric disorders. Syndromes such as depression may appear, subside, and recur during the course of disease progression. Integrating mental health services within a HIV/AIDS primary health care setting eliminates service fragmentation which increases better patient health outcomes. Description: El Rio Neighborhood Health Center, Special Immunology Associates is participating in a five-year study funded by the Substance Abuse and Mental Health Services Administration to implement and evaluate mental health services delivered in a HIV/AIDS primary care setting. To evaluate the study a set of screening and biopsychosocial assessments were adopted. The Global Appraisal of Individual Needs (GAIN) series of assessments screens the patients' mental health, substance use, stress, physical health, and service utilization generating recommendations for internal and external referrals. The assessment, referrals and disposition of referrals are part of the patient's medical record, allowing continuous communication between the mental health and medical providers. Lessons Learned: Co-locating mental health services in a primary medical setting does not eliminate service fragmentation. Service integration requires continuous communication, defined policies and procedures, a concrete plan and the buy in from administrators and providers (medical and mental health). Recommendations: Development of well defined policies and procedures, concrete implementation plan, continuous communication, minimal patient burden and the support of the administration. Specific policies, methodologies and strategies employed by El Rio/SIA are discussed.