A Model of Enhanced Primary Care for Patients with Severe Mental Illness.

Life expectancy and other outcomes for patients with serious mental illness (SMI) are unacceptably poor, largely due to a high prevalence of poorly controlled chronic diseases, high rates of tobacco use, and low rates of preventive care services. Since many of these illnesses are effectively treated in primary care settings, integrating primary care with behavioral health care is necessary to narrow health disparities for patients with SMI.

Systematic review of EBPs for SMI in rural America.

This systematic review of the implementation of evidence-based practices (EBPs) for adults with severe mental illnesses (SMI) in rural mental health settings examined peer-reviewed literature, grey literature, and public information. Included articles had to report implementation efforts of EBP(s) for SMI in rural settings or adaptations for rural service delivery. Only three peer-reviewed articles and two publicly available reports met inclusion criteria. Findings suggest little attention is focused on studying factors affecting implementation of EBPs for SMI in rural areas. Adaptations are occurring in rural settings, though rarely documented or tested; their impact on fidelity and consumer outcomes is unclear.

Moving an evidence-based intervention into routine mental health care: a multifaceted case example.

Many evidence-based interventions fail to translate into routine care for individuals experiencing significant mental health disorders. Moving the evidence-based intervention from the controlled research settings to the broader mental health systems is an ongoing challenge for administrators and practitioners in the mental health delivery network. In the United States, the movement to bring evidence-based mental health interventions into the public mental health system to enhance consumer recovery and improve outcomes has been a major thrust of federal and state efforts over the past 10 years (IOM, 2006; New Freedom Commission on Mental Health, 2003; Michigan Mental Health Commission, 2004; U.S. Department of Health and Human Services, 1999). Using a multifaceted case example, this article will address one state's efforts to implement an evidence-based intervention, Family Group Psychoeducation (FPE), into routine care for individuals living with schizophrenia and their families. The Consolidated Framework for Implementation Research (CFIR) (Damshcroder et al., 2009) guides the discussion of the dissemination efforts. This CFIR framework involves examining five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation.

Improving integrated general medical and mental health services in community-based practices.

The historical fragmentation of physical and mental health services has impeded efforts to improve quality and outcomes of care for persons with mental disorders. However, there is little information on effective strategies that might reduce fragmentation and improve integrated services within non-academic, community-based healthcare settings. Twenty-three practices from across the U.S. participated in a learning community meeting designed to identify barriers to integrated care and strategies for reducing such barriers. Barriers were initially identified based on a quantitative survey of organizational factors. Focus groups were used to elaborate on barriers to integrated care and to identify strategies for reducing barriers that are feasible in community-based settings. Participants identified key barriers, including administrative (e.g., lack of common medical records for mental health and general medical conditions), financial (e.g., lack of reimbursement codes to bill for mental health and general medical care in the same setting), and clinical (e.g., lack of an integrated care protocol). Top strategies recommended by participants included templates (i.e., for memoranda of understanding) to allow providers to work across practice settings, increased medical record security to enable a common medical record between mental health and general medical care, working with state Medicaid agencies to establish integrated care reimbursement codes, and guidance in establishing workflows between different providers (i.e., avoid duplication of tasks). Strategies to overcome barriers to integrated care may require cooperation across different organizational levels, including administrators, providers, and health care payers in order for integrated care to be established and sustained over time.