Literature Collection

BACKGROUND: Individuals with serious mental illness (SMI) die significantly earlier and experience disproportionately higher rates of physical health issues compared with non-SMI groups. Despite advances in care, this mortality gap persists. One factor that contributes to this discrepancy is inadequate access to healthcare, as individuals with SMI are less likely to receive appropriate medical care. METHODS: To better understand this, we completed a narrative review synthesizing existing literature on common barriers to care faced by the SMI community. We reviewed 34 articles and identified three primary barriers to receiving healthcare. RESULTS: These included structural and logistical barriers (geographic location, access to technology and internet, disjointed medical and mental healthcare); intrapersonal- and patient-level barriers (symptoms and psychological impact of SMI, lack of awareness or prioritization of medical issues, medical mistrust, and limited health literacy); and provider- and system-level barriers (lack of knowledge or support for integrated care, lack of knowledge of SMI, stigma, and diagnostic overshadowing). CONCLUSIONS: We argue that addressing these issues requires a reorientation toward person-centered approaches that prioritize continuity, integration, and dignity in care for individuals with SMI, and we offer specific recommendations in service of these aims.

BACKGROUND: Nearly 9 out of 10 youth who die by suicide visit health care settings in the year prior to their death. Given the opportunity of primary care to screen for youth suicide risk, past research has focused on understanding provider attitudes toward screening and barriers to screening implementation. However, research has not robustly examined how providers utilize information gathered from screening tools. Therefore, the aim of this qualitative study was to outline existing suicide protocols and characterize attitudes and practices toward youth suicide risk screening and subsequent triage. METHODS: Youth-serving primary care providers and clinic staff working at clinics in one Midwest health network participating in a randomized control trial implementing integrated behavioral health care were contacted via email by a research assistant. Nineteen individuals participated in 30-minute, semi-structured interviews regarding attitudes and practices toward youth suicide risk screening in primary care. Interviews were transcribed and analyzed using consensus deductive and inductive coding. RESULTS: Existing clinic workflow largely pertained to screening administration. Participants discussed the intention to universally screen pediatric patients using the Patient Health Questionnaire (PHQ)-2 for sick visits, which served as gate questions for the PHQ-9. For well child visits, clinics implemented universal PHQ-9 screeners. Participants were largely not aware of standardized processes, including brief suicide risk assessment, use of consultation services, or risk triage decision-making. Interviews described themes of attitudes toward youth suicide screening, primary care protocols, risk triage decision-making, and barriers and facilitators to youth suicide risk screening. Overall, providers and clinic staff expressed overwhelming confidence in administering screens, which was considered within their scope of practice. Confidence, however, wavered when providers discussed their ability and/or comfort determining follow-up steps, providing brief interventions, and connecting youth to behavioral health services. CONCLUSIONS: Results emphasize that without adequate behavioral health assessment and intervention post-screening, primary care providers face significant burden managing suicide risk, which was often felt outside their scope of practice. Developing and adapting intervention models within primary care (e.g., integrated care models) are crucial next steps.