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The White River model of colocated collaborative care: A platform for mental and behavioral health care in the medical home.

In the past two decades a great deal of research has demonstrated improved quality of care when mental health care is integrated into primary care. To date, most of the literature has addressed care management for specific mental illnesses. Such programs can be difficult to implement and sustain. We describe a program of "Colocated Collaborative Care," implemented in 2004 that has been sustained and grown over the 6 years since inception. The Primary Mental Health Care clinic at the White River Junction (Vermont) Veterans Affairs Medical Center offers a full spectrum of mental health care that allows 75% of referred patients to receive all of their care within the primary care clinic, thus conserving scarce specialty services for the most complex patients. The clinic is staffed by a therapist and a psychiatrist (or advanced practice nurse) and complemented by care management and health psychology. It makes use of technology to streamline assessment and track outcomes. The clinic provides a mix of care management, specialty expertise and chronic disease management. Originally developed in a capitated health care system, adherence to general principles that guided its development may be useful in any system of care.