VA's "Circle of Care" treats more than physicial issues

IRON MOUNTAIN – When a person thinks of going to see their doctor, it is typically for physical ailments. If that person is experiencing stress, depression, anxiety or anything else that affects him or her mentally, they are referred to a counselor or psychiatrist.

“The problem is, a patient often says ‘no’ when his or her primary care doctor offers a referral to see a mental health professional after observing something like depression or anxiety,” said Karen Krebsbach, a Licensed Medical Social Worker (LMSW) at the Oscar G. Johnson VA Medical Center.

“There is still a stigma in their minds about going to our Behavioral Health Service for treatment, especially with our older Veterans,” she said.

The VA Medical Center in Iron Mountain, Michigan is changing that by integrating medical and mental health care into a collocated and collaborative care environment.

In 2011, the VA Medical Center initiated and established the Circle of Care Clinic and located it within their Primary Care Service.

“The name, Circle of Care, really was born out of a discussion with one of our Native American Veterans,” said Krebsbach. “He said that when you treat someone, you need to treat the whole person – physical, emotional, mental and spiritual, and that is what we are about.” The “Circle” in the clinic’s name communicates wholeness of the Veteran.

The Circle of Care team consists of two Licensed Medical Social Workers, a Nurse Practitioner and a Health Technician and was nationally recognized in 2011 as one of eight top innovators in the VA for the Primary Care/Mental Health Integration Initiative.

“We are an extension of your normal doctor’s appointment,” said Cory Vedin, LMSW and Clinic team coordinator.

“Your doctor remains in charge of your health care,” said Vedin, “and it is our primary job to help you and your doctor develop the best integrated health care plan for whatever the problem is, be it depression, diabetes, insomnia, PTSD, anxiety, pain or any other worries or emotional concerns affecting daily life.”

The Circle of Care Clinic also provides recommendations and assistance for any specialty care that may be needed and follows up on medication usage for the Primary Care Clinic.

“Veterans are really surprised when we call them to see how they are doing with their meds,” said Cindy Ziller, the Nurse Practitioner on the Circle of Care Clinic team. “They say, ‘wow, you really care’, and we do because it is our passion.”

“The services we provide are not specialty mental health care but simply another part of your overall health care,” Vedin added. In fact, any Circle of Care clinical notes are entered into the Veteran’s medical record and not in a separate mental health file.

“We are here to help you with whatever problem or concern you are experiencing right now that is affecting your life, regardless of what official diagnoses you may have,” said Vedin. “For example, if you are diagnosed with substance abuse, but the death of a loved one is affecting you, we will deal with the loss and grief,” said Vedin.

Another key factor is same day access to the Circle of Care Clinic. If needed, Veterans can receive same day medication consultation or brief counseling.

“What we are finding is that, while some Veterans are resistant to seeing a psychiatrist in the Behavioral Health Service, they are much more open to coming to see us in the Circle of Care Clinic,” said Krebsbach.

Veterans can discuss the Circle of Care Clinic with their Primary Care doctor or call the clinic directly at 1-800-215-8262, extension 32555.