Authors :
Presenting Author: Poojith Nuthalapati, MD – Yale University | VA-Connecticut Healthcare System
Joey Utomo, BS – Yale University
Margaret Gopaul, PhD, MSCP – Yale University | VA-Connecticut Healthcare System
Hamada Altalib, DO, MPH, FAES – Yale University
Rationale:
Coordination of mental health care in Veterans with epilepsy and psychogenic non-epileptic seizures (PNES) is challenging. We investigated mental health care coordination across hub-spoke systems of care. Six distinct models were identified, ranging from embedded specialists (Center of Excellence, Specialty Integration) to distributed care (PACT, Community Care, Telehealth, MH Champion) (Fig. 1). We sought to determine the most utilized models of care and assess their coordination outcomes using social network analysis framework to identify gaps in care coordination.
Methods:
We conducted 51 semi-structured interviews with multidisciplinary team members from 19 VA Epilepsy Centers of Excellence (May 2024 -April 2025), including ECOE directors, epileptologists, and mental health providers. Using social network analysis, we mapped: (1) referral patterns, (2) collaborative relationships, and (3) patients’ volume between providers within and across care models. We measured effectiveness, accessibility, and coordination through structured assessments completed by participants rating the care model(s) utilized at their site. Provider ratings were analyzed using descriptive statistics. Referral patterns were visualized through network mapping (gephi 0.10.0).
Results:
Eighteen of 19 sites utilized multiple care models. The most prevalent were PACT (84%) and Telehealth (63%), followed by ECOE (47%). Less common were Community Care (37%), Mental Health Champion (37%), and Specialty Care (32%). Across models, providers rated themselves highly on effectiveness (mean 4.4/5.0) and accessibility (4.5/5.0). However, significant discrepancies were observed between self-reported workload and actual patient referral tracking. Network analysis revealed that PNES patients showed different referral patterns than epilepsy patients with MH comorbidities. PNES networks demonstrated more direct connections (edges) between MH and Neuro providers, forming integrated collaborative clusters for patient care coordination (Fig. 2). Both patient populations (thickness) exhibited isolated MH-Neuro provider clusters at select sites, suggesting fragmented care coordination despite high provider ratings.
Conclusions:
While multiple mental health care models coexist within VA epilepsy centers, significant gaps exist in care coordination and communication networks. The social network analysis reveals that provider perceptions of effectiveness do not align with measurable care coordination outcomes. Strengthening embedded specialist models, implementing formal referral tracking, and developing PNES-specific pathways are critical to optimize integration of mental health into epilepsy care.
Funding: VA ECOE QI Project