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Primary Care Rapid Mental Health Assessment and Triage (PCR-MHAT): An Evidence-Based Protocol
Meyer, Emily
Meyer, Emily
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Abstract
Access to timely mental health care continues to decline in rural states such as Vermont, increasing reliance on emergency departments (EDs) for psychiatric crises. Individuals in distress often contact their primary care provider (PCP) for guidance; however, outdated triage protocols and limited awareness of community resources frequently result in ED referral, despite EDs being poorly suited for trauma-informed mental health care. This quality improvement (QI) project implemented the Primary Care Rapid Mental Health Assessment and Triage (PCR-MHAT) protocol in a Central Vermont family medicine clinic to strengthen primary care response. PCR-MHAT integrates validated screening tools and standardized algorithms to support rapid acuity assessment and referral to appropriate levels of care, including ED alternatives such as Mental Health Urgent Care.
The protocol was piloted from September 15 to November 14, 2025. Evaluation included pre- and post-implementation surveys of registered triage nurses and retrospective review of telephone encounters. Eight nurses were eligible; six completed pre-implementation surveys and three completed post-implementation surveys. Chart review identified eight calls in which the PCR-MHAT template was used, most involving suicidal ideation and depressive symptoms. Screening results, community resource referrals, and follow-up plans were consistently documented.
Baseline confidence in mental health triage was high. Post-implementation confidence was lower but remained strong in general triage skills. Qualitative feedback indicated the protocol was easy to use, improved structured decision-making, increased awareness of crisis resources, and reduced uncertainty during high-stress calls. Findings suggest standardized mental health triage in primary care is feasible and promotes consistent assessment and referral.
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Date
2026-04-28