Enhancing Mental Health Care for Burn Survivors: A Burn Center-Based Stepped-Care Approach

Abstract

Burn injuries affect over half a million people in the United States (U.S.) annually, with 40,000 requiring hospitalization. Burn patients often experience significant psychological distress, with high rates of PTSD and depression. Undetected or untreated psychiatric symptoms can complicate recovery, prolong hospital stays, and increase risk of long-term problems and readmissions. Although burn centers are well-positioned to provide mental health services on both an inpatient and outpatient basis, few U.S. burn centers have robust programs to meet these needs - despite psychological screening and intervention being a requirement for American Burn Association verification. This study describes the development and early data from the Burn Behavioral Health (BBH) program, a burn center-based, technology-enhanced stepped-care model of delivering mental health services across the inpatient to outpatient continuum. BBH includes four steps: (1) initial screening, education, and early intervention; (2) symptom self-monitoring and self-help resources; (3) 30-day follow-up screening; and (4) provision of best-practice treatment via in-person or telehealth care, including individual and group therapy. Between February 2021 and October 2024, 1,203 eligible patients were identified (Mage=46.08, SDage=18.04; 67% male; 53% White; 38% Black); 919 (84%) completed initial screening. Nearly half (44%) screened positive for PTSD/depression risk and 95% of them received early intervention. The program reached 62% of patients for the 30-day follow-up, with 21% screening positive for PTSD/depression and 23% being interested in mental health services. These findings provide preliminary support for the BBH program, demonstrating its sustainability and capacity to engage a high proportion of burn patients across care settings, ultimately improving both access to and the quality of mental health care.

Keywords: PTSD; burn; depression; mental health; program; stepped care.