By Camille D. Ford | November 2025
Summary
Tracy Boswell, Acting Program Manager for Primary Care Mental Health Integration (PCMHI) at VA Tennessee Valley Healthcare System, leads a team that’s eliminating one of the biggest barriers to mental health care: stigma. By embedding mental health providers directly within primary care teams, PCMHI offers same-day consultations, crisis intervention, and brief therapy right in the familiar setting of a veteran’s regular doctor’s office. With over 22 years as a nurse practitioner and a passion for normalizing mental health care, Boswell is expanding access through Saturday clinics, virtual appointments, and cross-coverage models that ensure no veteran waits hours for help.
What Is PCMHI?
For veterans and families unfamiliar with the term, Traci Boswell puts it simply. PCMHI is a mental health team embedded within primary care. Each primary care team at VA Tennessee Valley Healthcare System has its own assigned PCMHI members, creating familiar partnerships built on trust and shared responsibility.
“We’re an extension of primary care,” Boswell explains. “We offer same-day access so veterans can get help right when they need it.”
That responsiveness becomes essential in crisis situations. If a veteran arrives with suicidal thoughts, PCMHI intervenes immediately, providing a safe, in-clinic assessment instead of delaying care or sending the veteran to an emergency room before support is available.
Why Primary Care Matters
What inspired Boswell to work at the intersection of primary care and mental health comes down to one word: stigma.
“There’s still so much stigma around mental health care today, so I think being able to meet with a mental health provider in the kind of safety of your primary care office during that appointment decreases the stigma. It kind of normalizes mental health. It’s just another condition that we treat, just like we would treat diabetes or hypertension. I just think it reduces that stigma overall.”
There’s a practical benefit too. “It’s also really convenient for the veteran. They’re already there seeing their primary care provider, so they have the option to just talk to someone else and get some of their needs met.”
Boswell worked in general mental health settings before joining the PCMHI team a few months ago. The difference is striking. “In this setting, most of the time we’re able to stabilize the patients within those few sessions and return them back to primary care instead of referring them to a higher level.”
The Vision: Cross-Coverage and Quick Access
Boswell recently stepped into her role as Acting Program Manager after just passing her four-year mark at VA Tennessee Valley Healthcare System. Her vision centers on one goal: making sure no veteran waits.
“Right now, the biggest thing we’re doing is we’re going to try to implement a cross-coverage site so we can cover across multiple sites. So, if one mental health primary care team has a couple of same-day warm handoffs at one time, we can have someone from another site assist so that the veteran is not waiting for a couple of hours to see someone. We can get them taken care of right then.”
The model can incorporate virtual care when needed, reducing wait times and offering quicker availability across Tennessee Valley’s multiple locations.
How PCMHI Changes Everything
Traditional mental health care often involves separate clinics, unfamiliar providers, anxiety about what questions might be asked. PCMHI removes those barriers.
“The thought of going to a mental health clinic, a separate office with all that, can be anxiety-provoking for a lot of people. There’s uncertainties about who they’ll see, what questions might be asked, what will happen, will this provider understand what I’m going through.”
With PCMHI, it’s different. “It’s easy. It feels comfortable because their provider that they know and trust in primary care is giving a warm handoff to this person that they trust with their care. They don’t have to travel to another clinic. I just think that in-office warm handoff eases a lot of that anxiety for the veteran.”
What a Same-Day Visit Looks Like
The process is remarkably straightforward, designed to feel natural rather than clinical.
A veteran shows up for their primary care doctor visit. During the nursing assessment, nurses ask questions about depression and PTSD through standard questionnaires. Sometimes that triggers a need for follow-up. Other times, during the visit with their doctor or nurse practitioner, the veteran mentions feeling depressed or stressed.
“At that point, the primary care doctor will usually get consent. That is one thing we do have to say, ‘Would you like to speak to a mental health provider today at the end of our visit? We have someone here that can talk to you right afterwards.’ If they agree, then typically the mental health provider will come into that exam room, take over the visit from there, speak to the veteran about all of our services and our options for treatment, and then refer or schedule them back.”
In crisis situations, the response is immediate. “In the instance where a veteran may be in a suicidal crisis, we use the Columbia-Suicide Severity Rating Scale questionnaire. If they do have a positive indicator on that, we are automatically brought into the situation to assess safety as the mental health experts there. They’ll complete a full safety assessment and then decide next steps, if anything further is needed for their treatment – hospitalization or just safety planning and things like that.”
What Brings Veterans to PCMHI
The concerns vary widely. Depression and anxiety. PTSD, probably the most common. Life stressors such as divorce, death in the family, loss of a job, financial stress.
“We’re seeing a lot of that right now with just the condition of everything going on. So sometimes they just need someone to talk to.”
Sometimes veterans are present in crisis. “I think that’s a great area where PCMHI can step in and make it not feel so scary. A lot of veterans are sometimes afraid to say they’re feeling suicidal because they don’t want to get locked up. And so, I think PCMHI is a great sounding board for that, a kind of soft landing to help that not feel so scary.”
Meeting Reluctance with Options
When veterans are reluctant or unsure about seeking mental health support, Boswell’s team offers choices.
“Our PCMHI providers do a really good job of offering all the avenues of treatment for patients to choose from. We have brief therapy options. We have support groups. We have a peer support specialist, which a lot of veterans would much prefer to talk to another veteran who’s been through some of the same things.”
The team provides brief medication management, starting veterans on medication and returning them to primary care if appropriate. “It’s just done in a very low-pressure environment. Again, you’re still in your primary care doctor’s office, so it feels less stressful, less pressure for that. At the end of the day, the veteran gets to choose that next step in their treatment. It’s a collaborative decision. There’s no long-term commitment with PCMHI. It normalizes the treatment for mental health.”
Catching Problems Early
Early intervention often starts with questionnaires sent out prior to appointments or completed during nursing assessments – questions about depression, stress, intimate partner violence, suicide risk.
But primary care doctors are also skilled at reading between the lines.
“Veterans just may mention things in their primary care visit, and I think primary care doctors are really astute at, ‘Oh, you’re having trouble sleeping. What’s keeping you from sleeping at night? Oh, you’re worried about things.’ Or, ‘I haven’t seen my family in a while. I don’t like to go out with my friends anymore’ – social isolation. ‘I have trouble getting up and going to work in the mornings or I have trouble getting out of bed and getting showered.’ Those little things they can pick up on are cues that the veteran may need additional support.”
That’s when they ask: “Hey, it sounds like maybe you’re having a rough time. Would you like to talk to somebody today about that? They can listen and maybe give you some help.”
The Results: Quick Stabilization
For many veterans, PCMHI provides exactly what they need without escalating to higher levels of care.
“We aim for six to eight sessions, and a lot of times we’re able to stabilize the patient, teach them some coping skills, get their medication straightened out, and refer them all the way back to primary care so that they’re not in a general mental health clinic.”
The numbers tell the story. “Greater than 50% of our patients get returned back to primary care.”
This quick intervention means veterans aren’t waiting six to eight weeks to see a provider in a mental health clinic. It keeps them at the lowest level of care, freeing up general mental health clinics to treat more severe symptoms.
Balancing Structure with Compassion
The PCMHI model builds compassion into its structure through flexibility.
“A lot of our providers’ time is kind of carved out for same-day warm handoffs. They’re not scheduled with 15 patients in their day and they just have to squeeze someone in, and that’s very obvious to patients when they’re being rushed through an appointment.”
When a provider receives a warm handoff, their time is fully committed to that veteran. “They’re not worried about, ‘Oh, I’ve got another patient in 10 minutes, I’ve got to hurry through this.’ They also don’t carry a large caseload, so most of their time is flexible. They’re able to get people back in quickly and manage the situation that’s in front of them without any concern for time constraints making them late for the next patient.”
The Power of Communication
Teamwork between primary care providers and behavioral health specialists hinges on one thing: communication.
“We usually communicate through Teams. Each primary care team kind of has their little chat with their primary care mental health providers on that, so they work together. They get to know each other because it’s the same team. They’ve been working together for years.”
The collaboration happens naturally. “A lot of times they’ll see each other in the hall, grab them out of their office in the hallway. I see the chats. I’m on a lot of them, so I see the collaboration. It’s great. You can tell that everybody in there just wants the best thing for the patient. I think that’s the most important thing, is that communication.”
A Success Story
Out of respect for patient privacy, Boswell keeps details vague, but the story illustrates PCMHI’s impact.
Recently a veteran came to their medical appointment tearful and upset after the loss of a family member. They engaged with one of the PCMHI therapists. The therapist provided brief grief therapy and introduced depression management skills. The veteran met with that provider once a month for several months.
Over time, they improved their connection with friends and family. They got active again, back into exercise. By the end of treatment, they reported significant reduction in depression and grief.
“Instead of being immediately sent out to a general mental health clinic, their symptoms were treated right there in PCMHI, and they were able to stay within that model.”
Expanding Access
The veteran population continues to grow, and VA Tennessee Valley Healthcare System keeps expanding to meet demand.
“We’re offering Saturday clinics for new patients to help get new patients in. When we do have Saturday clinics, PCMHI providers are also available on Saturdays for same-day access too, so we go right along with primary care in increasing access.”
The system is actively securing more space to expand programs. The big hope? “To improve our access with this cross-coverage model.”
Sometimes on Saturdays, they have virtual clinics in Nashville and Murfreesboro with a provider physically stationed in Clarksville available virtually to handle any issues. “Our goal is to improve that cross-coverage model so that we can reach more veterans and still keep the same-day access there.”
Technology as a Tool
Virtual appointments have significantly improved the ability to deliver care, especially to veterans in remote areas.
“A lot of our same-day warm handoffs from primary care are in person, which is the best way to do it if at all possible. But sometimes the follow-up visits, it’s not always convenient for the veteran to drive back to the doctor’s office for those recurring PCMHI appointments.”
The team sets up virtual visits, often doing test runs while veterans are still in the clinic. “We can send them a test link and make sure that they’re able to connect and use the platform, which is a very easy virtual platform for patients to use. It’s significantly improved our access.”
The Next Three to Five Years
Boswell’s biggest goal centers on that cross-coverage model.
“We’re going to develop shared cross-coverage, shared grids that help us capture some of our same-day access metrics to make sure that we’re reaching everybody the same day. That’s one of our biggest goals that we’re going to be working on.”
What Veterans Day Means
Boswell didn’t serve in the military, but many of her family members did. For her, working at VA is a way to give back.
“This is one way I feel like I can give back to my country since I didn’t serve myself. It’s my highest honor and privilege to do this, truly, to serve veterans every day.”
Veterans Day offers a moment to pause. “It helps me remember and reflect on everything, the sacrifices they’ve all made – not just physical sacrifices, but emotional, obviously, that all the military members made on my behalf, without me asking for it, without me deserving it.”
But the real work happens daily. “It’s a special day that we honor once a year, but every day, that’s what I want to do. I honor those veterans.”
Taking Care of the Caregivers
Anyone working in mental health has to learn boundaries, has to learn to turn it off when they go home to relax and recharge and reset.
“That’s hard sometimes. It’s hard to sometimes turn that off and not think about our veterans when we leave.”
But Boswell has support. “We have wonderful leadership. I’m surrounded by great leaders. All the leaders help – we’re all checking in on each other. We’re constantly checking in on our supervisees, our employees that work under us. It’s a great team, a great collaborative team here at Tennessee Valley Healthcare System.”
She smiles, thinking about it. “I think we do a great job. We understood the assignment.”
No Room for Outside Noise
Boswell doesn’t encounter veterans who aren’t grateful for PCMHI’s help.
“I’ve worked in other mental health settings where the appreciation is not there. So, the veterans I feel are grateful every day for it.”
There’s always public perception about VA and the federal government. “But we don’t let that bother us. We know what we’re here for. I’m here for the mission. I don’t listen to the outside noise.”
Resources for Veterans and Healthcare Professionals
VA Mental Health Services
- VA Mental Health Services: Mental Health Home
- Veterans Crisis Line: Dial 988, then press 1 | Text 838255 | Veterans Crisis Line
- Make the Connection (veteran mental health resources): Make the Connection | Videos & Info for Military Veterans
VA Tennessee Valley Healthcare System
- TVHS Main Site: VA Tennessee Valley Health Care | Veterans Affairs
- Nashville VA Medical Center: 1310 24th Avenue South, Nashville, TN 37212
- Mental Health Care: VA Mental Health Services | Veterans Affairs
Primary Care Mental Health Integration
- PCMHI Information: Primary Care – Mental Health Integration (PC-MHI) – Patient Care Services
- Crisis and Support Resources
- PTSD Support: PTSD: National Center for PTSD Home
- Substance Use Disorder Treatment: Substance Use Treatment For Veterans | Veterans Affairs
- Caregiver Support: VA Caregiver Support Program Home
About Tracy Boswell
Tracy Boswell, NP is Acting Program Manager for Primary Care Mental Health Integration at VA Tennessee Valley Healthcare System. With 22 years of experience as a nurse practitioner, she has worked in both general mental health and integrated care settings. Boswell is passionate about reducing stigma around mental health care and expanding same-day access for veterans across Tennessee Valley’s multiple locations.
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