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.
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.
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.
Bachrach, L. (1988). Continuity of care for chronic mental patients: A conceptual analysis. American Journal of Psychiatry, 138(11), 1449–1456.
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.
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.
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.
Chen, J., & Hou, F. (2002). Unmet needs for health care. Health Reports, 13(2), 23–34.
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.
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.
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.
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.
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.
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.
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.
Fleury, M., Grenier, G., Bamvita, J., et al. (2010). Professional service utilisation among patients with severe mental disorder. BMC Health Services Research, 10, 141.
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.
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.
Kates, N. (2008). Promoting collaborative care in Canada: The Canadian Collaborative Mental Health Initiative. Families, Systems and Health, 26(4), 466–473.
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.
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.
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.
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.
Mangalore, R., & Knapp, M. (2006). Equity in mental health. Epidemiologia e Psichiatria Sociale, 15(4), 260–266.
Marwaha, S., & Johnson, S. (2004). Schizophrenia and employment – a review. Social Psychiatry and Psychiatric Epidemiology, 39(5), 337–349.
Meadows, G. N. (1998). Establishing a collaborative service model for primary mental health care. Medical Journal of Australia, 168(4), 162–165.
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.
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.
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.
Neale, J. (2004). Measuring the health of Scottish drug users. Health and Social Care in the Community, 12(3), 202–211.
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.
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.
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.
Shah, B. R. (2008). Utilization of physician services for diabetic patients from ethnic minorities. Journal of Public Health, 30(3), 327–331.
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.
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.
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.
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.
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.
Thornicroft, G., & Tansella, M. (1999). Translating ethical principles into outcome measures for mental health service research. Psychological Medicine, 29(4), 761–767.
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.
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.
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.
World Health Organization. (2008). Integrating mental health into primary care: A global perspective. Singapore: World Health Organization/WONCA: The World Organization of Family Doctors.
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
Corresponding author
Rights 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
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10879-011-9185-1