Serious Mental Illness: Integrating Behavioral Health and Primary Care Review


This report examined the evidence regarding the integration of behavioral health and primary care services for individuals with serious mental illness (SMI) and/or substance use disorder. Moderate evidence suggests that the use of fully integrated services or care management with enhanced collaboration improves mental health outcomes and the use of preventative services for adult patients with bipolar disorder and other SMIs. Such interventions often require additional staff, training, and ongoing support of care managers.

Interventions that included care management for bipolar disorder patients demonstrated improved mania, mental health-related quality of life measures, and access to medical care over 12 months. These interventions were found to be cost neutral over 36 months. Integrated care enhanced by trained nurse care managers improved mental health-related quality of life measures and use of preventive services.

Among studies examining patients with chemical dependency, moderate evidence suggested that on-site integrated medical care including team meetings and joint treatment playing improved abstinence rates and chemical dependency symptoms. Interventions that used colocation of primary care and behavioral health services without enhanced coordination and collaboration had little association with improved patient outcomes among patients with substance use disorder.

This report was compiled by the Milbank Memorial Fund for the Reforming States Group.

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