The physical health status of people with severe mental illness (SMI) is a public health crisis. Individuals with SMI (e.g. schizophrenia, bipolar disorder, or severe depression) are more likely than the general population to suffer from physical health conditions, including hypertension, diabetes, obesity, cardiovascular disease, HIV, and hepatitis. SMI is associated with a reduction of about 9 years in life expectancy, about half of which is attributable to physical health conditions. Poor access to and low quality of health care contributes to these disparities. A leading proposal for improving the health of people with SMI is to integrate primary care services into specialty mental health clinics which already serve as their primary gateway into the medical system. However, the viability of this strategy to achieve sustained system-wide improvements in care for people with SMI has yet to be examined. This project takes advantage of two innovative integrated care programs and a unique data resource in New York State to assess the potential impact of integrating primary care services into specialty behavioral health clinics for people with SMI. The first integrated care program in New York was established through a Substance Abuse and Mental Health Services Administration (SAMHSA) demonstration project, the Primary Behavioral Health Care Integration (PBHCI) grant program. The RAND Corporation was awarded a contract from SAMHSA and the Assistant Secretary for Planning and Evaluation (ASPE) to evaluate the effectiveness of this program. The second integrated care program was initiated by the New York Office of Mental Health using a Medicaid reimbursement incentive to promote primary care services in specialty behavioral health clinics. The OMH program, which is on a much larger scale than the SAMHSA grant program, has yet to be examined empirically with respect to its impact on health care. For this project, the RAND research team has joined with a research team at NYU with extensive experience with quality of mental health care research in New York's Office of Mental Health. Together we will examine the financial viability of integrated care from the clinics'perspective, the impact of integrated care on health care utilization, quality, ad cost from a health system perspective and the long term budget impact of integrated care from the payer perspective. Data for this evaluation come from a unique resource of Medicaid claims data. If this model is successful, then expanding its availability could have a dramatic impact on the physical health status of people with SMI, helping to reduce one of the starkest of contemporary disparities in health. Determining the viability of this model is urgent because of the anticipated growth of public sector mental health care and in state-level programs designed to incentivize integrated care for people with SMI.

Public Health Relevance

People with Serious Mental Illness are high users of medical care yet receive fewer and lower quality health care services for physical health conditions than the general population, a fact which contributes to large health disparities. Providing physical health care in the specialty behavioral health care clinics where people with SMI are commonly treated for their mental illnesses has been suggested in the literature as a way to improve their treatment, and preliminary evaluations of this model under research conditions have been promising. This project will test the 'real world'viability of this integrated care strategy in Ne York State, where the combination of innovative programming and available data provide the first opportunity to test its impact in a large scale public mental health system.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (SERV)
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Rupp, Agnes
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Rand Corporation
Santa Monica
United States
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Breslau, Joshua; Leckman-Westin, Emily; Han, Bing et al. (2018) Impact of a mental health based primary care program on emergency department visits and inpatient stays. Gen Hosp Psychiatry 52:8-13
Connor, Kathryn L; Breslau, Joshua; Finnerty, Molly T et al. (2018) Integrating physical health: What were the costs to behavioral health care clinics? Gen Hosp Psychiatry 51:41-45
Breslau, Joshua; Leckman-Westin, Emily; Yu, Hao et al. (2018) Impact of a Mental Health Based Primary Care Program on Quality of Physical Health Care. Adm Policy Ment Health 45:276-285
Ramanuj, Parashar Pravin; Talley, Rachel; Breslau, Joshua et al. (2018) Integrating Behavioral Health and Primary Care Services for People with Serious Mental Illness: A Qualitative Systems Analysis of Integration in New York. Community Ment Health J 54:1116-1126
Breslau, Joshua; Yu, Hao; Horvitz-Lennon, Marcela et al. (2017) Enrollment of Specialty Mental Health Clinics in a State Medicaid Program to Promote General Medical Services. Psychiatr Serv 68:63-69