Skip to main content

Advertisement

Log in

Examining Factors Associated with Primary Care and Continuity of Care Among Adults with Severe Mental Illness

  • Published:
Journal of Contemporary Psychotherapy Aims and scope Submit manuscript

Abstract

A number of studies have consistently reported that there is a greater prevalence of mental illness among the most socioeconomically disadvantaged. At the same time, there is evidence that services are not optimally accessed by the most socioeconomically disadvantaged; the most in need of care are also the most likely to have unmet healthcare needs. Of people with mental illnesses, those with severe mental illnesses (SMI) are the most at risk of poverty and the least likely to have optimal care. In the past, specialized community mental health services have been identified as the primary provider for people with SMI. However, there is growing interest in using the primary care setting as the main source of mental health care where both medical treatment and psychotherapy can be accessed. In this paper, we examine factors related to primary care use (and in turn, pharmacologic and psychotherapies) for people who are socioeconomically disadvantaged and who have a SMI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Allen, J. P., Litten, R. Z., Fertig, J. B., et al. (1997). A review of research on the Alcohol Use Disorders Identification Test (AUDIT). Alcoholism, Clinical and Experimental Research, 21(4), 613–619.

    Article  PubMed  CAS  Google Scholar 

  • Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., et al. (2001). The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care. Geneva: World Health Organization.

    Google Scholar 

  • Bachrach, L. (1988). Continuity of care for chronic mental patients: A conceptual analysis. American Journal of Psychiatry, 138(11), 1449–1456.

    Google Scholar 

  • Boyer, C. A., McAlpine, D. D., Pottick, K. J., et al. (2000). Identifying risk factors and key strategies in linkage to outpatient psychiatric care. American Journal of Psychiatry, 157(10), 1592–1598.

    Article  PubMed  CAS  Google Scholar 

  • Brazier, J. E., Harper, R., Jones, N. M., et al. (1992). Validating the SF-36 health survey questionnaire: New outcome measure for primary care. British Medical Journal, 305(6846), 160–164.

    Article  PubMed  CAS  Google Scholar 

  • Brown, R. L., & Rounds, L. A. (1995). Conjoint screening questionnaires for alcohol and other drug abuse: Criterion validity in a primary care practice. Wisconsin Medical Journal, 94(3), 135–140.

    PubMed  CAS  Google Scholar 

  • Chen, J., & Hou, F. (2002). Unmet needs for health care. Health Reports, 13(2), 23–34.

    Google Scholar 

  • College of Physicians and Surgeons of Alberta. (2005). Cited April 25, 2005.

  • College of Physicians and Surgeons of British Columbia. (2005). Cited April 25, 2005.

  • College of Physicians and Surgeons of Ontario. (2005). Cited April 25, 2005.

  • College of Physicians and Surgeons of Ontario. (2009). Partnerships annual report. Toronto: College of Physicians and Surgeons of Ontario.

  • Compton, M. T., Rudisch, B. E., Craw, J., et al. (2006). Predictors of missed first appointments at community mental health centers after psychiatric hospitalization. Psychiatric Services, 57(4), 531–537.

    Article  PubMed  Google Scholar 

  • Cuffel, B. J., Held, M., & Goldman, W. (2002). Predictive models and the effectiveness of strategies for improving outpatient follow-up under managed care. Psychiatric Services, 53(11), 1438–1443.

    Article  PubMed  Google Scholar 

  • Daumit, G. L., Crum, R. M., Guallar, E., et al. (2002). Receipt of preventive medical services at psychiatric visits by patients with severe mental illness. Psychiatric Services, 53(7), 884–887.

    Article  PubMed  Google Scholar 

  • Dewa, C. S., Durbin, J., Eastabrook, S., et al. (2002). Considering a multi-site study? Taking the leap and having a soft landing. Journal of Community Psychology, 30(3), 1–15.

    Google Scholar 

  • Dewa, C. S., Loong, D., & Trojanowski, L. (2010). The matryoshka project: Examining the standard of living of clients. Toronto: Centre for Addiction and Mental Health.

  • Dickey, B., Normand, S. L., Weiss, R. D., et al. (2002). Medical morbidity, mental illness, and substance use disorders. Psychiatric Services, 53(7), 861–867.

    Article  PubMed  Google Scholar 

  • Dixon, L., Goldberg, R., Iannone, V., et al. (2009). Use of a critical time intervention to promote continuity of care after psychiatric inpatient hospitalization. Psychiatric Services, 60(4), 451–458.

    Article  PubMed  Google Scholar 

  • Dunlop, S., Coyte, P. C., & McIsaac, W. (2000). Socio-economic status and the utilisation of physicians’ services: Results from the Canadian National Population Health Survey. Social Science and Medicine, 51(1), 123–133.

    Article  PubMed  CAS  Google Scholar 

  • Fleury, M., Grenier, G., Bamvita, J., et al. (2010). Professional service utilisation among patients with severe mental disorder. BMC Health Services Research, 10, 141.

    PubMed  Google Scholar 

  • Gelberg, L., Gallagher, T. C., Andersen, R. M., et al. (1997). Competing priorities as a barrier to medical care among homeless adults in Los Angeles. American Journal of Public Health, 87(2), 217–220.

    Article  PubMed  CAS  Google Scholar 

  • Hwang, S. W., Ueng, J. J., Chiu, S., et al. (2010). Universal health insurance and health care access for homeless persons. American Journal of Public Health, 100(8), 1454–1461.

    Article  PubMed  Google Scholar 

  • Kates, N. (2008). Promoting collaborative care in Canada: The Canadian Collaborative Mental Health Initiative. Families, Systems and Health, 26(4), 466–473.

    Article  Google Scholar 

  • Klinkenberg, W. D., & Calsyn, R. J. (1996). Predictors of receipt of aftercare and recidivism among persons with severe mental illness: A review. Psychiatric Services, 47(5), 487–496.

    PubMed  CAS  Google Scholar 

  • Koegl, C., Durbin, J., & Goering, P. (2004). Mental health services in Ontario: How well is the province meeting the needs of persons with serious mental illness? Toronto: Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health.

    Google Scholar 

  • Koizumi, N., Rothbard, A. B., & Kuno, E. (2009). Distance matters in choice of mental health program: policy implications for reducing racial disparities in public mental health care. Administration and Policy in Mental Health, 36(6), 424–431.

    Article  PubMed  Google Scholar 

  • Kreyenbuhl, J., Nossel, I. R., & Dixon, L. B. (2009). Disengagement from mental health treatment among individuals with schizophrenia and strategies for facilitating connections to care: A review of the literature. Schizophrenia Bulletin, 35(4), 696–703.

    Article  PubMed  Google Scholar 

  • Mangalore, R., & Knapp, M. (2006). Equity in mental health. Epidemiologia e Psichiatria Sociale, 15(4), 260–266.

    PubMed  Google Scholar 

  • Marwaha, S., & Johnson, S. (2004). Schizophrenia and employment – a review. Social Psychiatry and Psychiatric Epidemiology, 39(5), 337–349.

    Google Scholar 

  • Meadows, G. N. (1998). Establishing a collaborative service model for primary mental health care. Medical Journal of Australia, 168(4), 162–165.

    PubMed  CAS  Google Scholar 

  • Meneses-Gaya, C., Zuardi, A. W., Loureiro, S. R., et al. (2010). Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. Alcoholism, Clinical and Experimental Research, 34(8), 1417–1424.

    PubMed  Google Scholar 

  • Miller, W. R., Zweben, A., DiClemente, C. C., et al. (1992). Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence (Vol. 2). Rockville: NIAAA.

    Google Scholar 

  • Morris, J. N., Dopnkin, A. J. M., Wonderling, D., et al. (2000). A minimum income for healthy living. Journal of Epidemiology and Community Health, 54, 885–889.

    Article  PubMed  CAS  Google Scholar 

  • Neale, J. (2004). Measuring the health of Scottish drug users. Health and Social Care in the Community, 12(3), 202–211.

    Article  PubMed  Google Scholar 

  • Nesvag, R., Lange, E. H., Faerden, A., et al. (2010). The use of screening instruments for detecting alcohol and other drug use disorders in first-episode psychosis. Psychiatry Research, 177(1–2), 228–234.

    Article  PubMed  Google Scholar 

  • Olfson, M., Marcus, S. C., & Doshi, J. A. (2010). Continuity of care after inpatient discharge of patients with schizophrenia in the Medicaid program: A retrospective longitudinal cohort analysis. Journal of Clinical Psychiatry, 71(7), 831–838.

    Article  PubMed  Google Scholar 

  • Ontario Ministry of Health and Long-Term Care. (2005). Guide to interdisciplinary team roles and responsibilities. Toronto: Ontario Ministry of Health and Long-Term Care.

  • Samet, J. H., Friedmann, P., & Saitz, R. (2001). Benefits of linking primary medical care and substance abuse services: Patient, provider, and societal perspectives. Archives of Internal Medicine, 161(1), 85–91.

    Article  PubMed  CAS  Google Scholar 

  • Shah, B. R. (2008). Utilization of physician services for diabetic patients from ethnic minorities. Journal of Public Health, 30(3), 327–331.

    Article  PubMed  Google Scholar 

  • Siefert, K., Heflin, C. M., Corcoran, M. E., et al. (2004). Food insufficiency and physical and mental health in a longitudinal survey of welfare recipients. Journal of Health and Social Behavior, 45(2), 171–186.

    Article  PubMed  Google Scholar 

  • Steele, L., Dewa, C., & Lee, K. (2007). Socioeconomic status and self-reported barriers to mental health service use. Canadian Journal of Psychiatry, 52(3), 201–206.

    Google Scholar 

  • Steele, L., Glazier, R. H., Agha, M., et al. (2009). The gatekeeper system and disparities in use of psychiatric care by neighbourhood education level: Results of a nine-year cohort study in Toronto. Healthcare Policy, 4(4), e133–e150.

    PubMed  Google Scholar 

  • Stein, B. D., Kogan, J. N., Sorbero, M. J., et al. (2007). Predictors of timely follow-up care among medicaid-enrolled adults after psychiatric hospitalization. Psychiatric Services, 58, 1563–1569.

    Article  PubMed  Google Scholar 

  • Stewart, M., Reutter, L., Makwarimba, E., et al. (2005). Determinants of health-service use by low-income people. Canadian Journal of Nursing Research, 37(3), 104–131.

    PubMed  Google Scholar 

  • Thornicroft, G., & Tansella, M. (1999). Translating ethical principles into outcome measures for mental health service research. Psychological Medicine, 29(4), 761–767.

    Article  PubMed  CAS  Google Scholar 

  • United Nations Economic and Social Council. (2000). General comment no. 14. The right to the highest attainable standard of health (E/C.12/2000/4. (General Comments)). New York City: United Nations Committee on Economic, Social & Cultural Rights, 22nd Session.

  • Vasiliadis, H. M., Tempier, R., Lesage, A., et al. (2009). General practice and mental health care: Determinants of outpatient service use. Canadian Journal of Psychiatry, 54(7), 468–476.

    Google Scholar 

  • Ware, J. E. J., Kosinski, M., Bjorner, J. B., et al. (2007). User’s manual for the SF-36v2 Health Survey (2nd ed.). Lincoln, RI: QualityMetric Incorporated.

    Google Scholar 

  • Wood, S. K., Campbell, A. K., Marden, J. D., et al. (2009). Inpatient care to community care: Improving clinical handover in the private mental health setting. Medical Journal of Australia, 190(11 Suppl), S144–S149.

    PubMed  Google Scholar 

  • World Health Organization. (2008). Integrating mental health into primary care: A global perspective. Singapore: World Health Organization/WONCA: The World Organization of Family Doctors.

Download references

Acknowledgments

The authors would like to thank the anonymous reviewers for their helpful suggestions. The authors are also grateful for the excellent research assistance provided by Nancy Chau, Desmond Loong, Lucy Trojanowski and Halina Trojanowska. This project was funded by the Canadian Institutes of Health Research. Dr. Dewa also gratefully acknowledges the support provided by her CIHR/PHAC Applied Public Health Chair. The Centre for Addiction and Mental Health receives funding from the Ontario Ministry of Health and Long-Term Care to support research infrastructure.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carolyn S. Dewa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dewa, C.S., Tugg, L., Stergiopoulos, V. et al. Examining Factors Associated with Primary Care and Continuity of Care Among Adults with Severe Mental Illness. J Contemp Psychother 42, 45–54 (2012). https://doi.org/10.1007/s10879-011-9185-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10879-011-9185-1

Keywords

Navigation