Authors :
Presenting Author: Margaret Gopaul, PhD, MSCP – Yale University | VA-Connecticut Healthcare System
Poojith Nuthalapati, MD – Yale University | VA-Connecticut Healthcare System
Joey Utomo, BS – Yale University
Hamada Altalib, DO, MPH, FAES – Yale University
Rationale:
Veterans with epilepsy and Functional Neurological Disorders (FND) experience disproportionate mental health comorbidities —PTSD (60%), depression (48%), and anxiety disorders—alongside elevated suicide risk compared to the general population. Despite various care delivery models, mental health integration within epilepsy care remains inconsistent. The 2024 VA Models for Integrating and Championing (Mental) Health (MICH) initiative assessed mental health services delivery at 19 VA Epilepsy Centers of Excellence (ECoE), aiming to map care models, evaluate effectiveness and barriers, promote sustainable patient-centered integration, address coordination and funding gaps, and guide model transitions and training.
Methods:
We conducted 51 semi-structured interviews (May 2024–April 2025) with multidisciplinary teams—including ECoE directors, epileptologists, and mental health providers—across all 19 participating VA ECoE. Interviews were transcribed and analyzed in NVivo v14 using combined inductive and deductive thematic coding to identify barriers, facilitators, and best practices for integrating mental health into epilepsy care.
Results:
Mental health care coordination models varied widely, from embedded providers to external referrals. Sixteen major themes emerged across four domains: care delivery models, organizational factors, provider resources, and patient-centered approaches. Key facilitators included embedded mental health providers, effective interdisciplinary communication, telehealth expansion, and structural administrative support (Table 1:1). Major barriers included high patient demand, insufficient specialists, long wait times, limited specialized training, resource constraints, and community care coordination challenges (Table 1:2). VA’s unique capacity to serve this population was consistently recognized, and providers expressed optimism for the expansion of specialized services. Embedded providers in the department emerged as the preferred model, though limited by resource availability. The VA Mind Brain Program was identified as a key resource for FND training and consultation across sites (Figure 1).
Conclusions:
The MICH initiative highlights a critical opportunity to strengthen mental health integration in epilepsy care within the VA system. While multiple care delivery models exist for mental health integration in epilepsy care, success depends heavily on communication quality, provider expertise, and organizational support. Findings suggest prioritizing embedded specialist models, enhancing interdisciplinary collaboration, and leveraging and expanding telehealth while addressing systemic resource constraints. These findings can guide evidence-based implementation strategies for improving mental health integration in epilepsy care across the VA healthcare system.
Funding: VA ECoE