Skip to main content
PMC home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1998 Oct;169(4):245–250.

Primary care for those with severe and persistent mental illness.

C Crews 1, H Batal 1, T Elasy 1, E Casper 1, P S Mehler 1
PMCID: PMC1305304  PMID: 9795595

Abstract

Historically, the medical care of persons with severe and persistent mental illness (SPMI) has been suboptimal. In many communities, large gaps exist in the continuum of services necessary to meet the medical needs of those patients, and existing services are not well coordinated. The effect of the managed mental health care on patients with SPMI remains to be seen, but it does not bode well for patients who are already at risk for being undertreated. We initiated primary care clinics exclusively for patients with SPMI because of our belief that integrating primary care and mental health services offers the best hope of improving health care for those patients. Our experience to date is instructive for other health care systems.

Full text

PDF
246

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barry K. L., Fleming M. F., Greenley J. R., Kropp S., Widlak P. Characteristics of persons with severe mental illness and substance abuse in rural areas. Psychiatr Serv. 1996 Jan;47(1):88–90. doi: 10.1176/ps.47.1.88. [DOI] [PubMed] [Google Scholar]
  2. Bindman A. B., Grumbach K., Osmond D., Vranizan K., Stewart A. L. Primary care and receipt of preventive services. J Gen Intern Med. 1996 May;11(5):269–276. doi: 10.1007/BF02598266. [DOI] [PubMed] [Google Scholar]
  3. Birnbaum A., Gallagher J., Utkewicz M., Gennis P., Carter W. Failure to validate a predictive model for refusal of care to emergency-department patients. Acad Emerg Med. 1994 May-Jun;1(3):213–217. doi: 10.1111/j.1553-2712.1994.tb02434.x. [DOI] [PubMed] [Google Scholar]
  4. Breakey W. R., Fischer P. J., Kramer M., Nestadt G., Romanoski A. J., Ross A., Royall R. M., Stine O. C. Health and mental health problems of homeless men and women in Baltimore. JAMA. 1989 Sep 8;262(10):1352–1357. [PubMed] [Google Scholar]
  5. D'Ercole A., Skodol A. E., Struening E., Curtis J., Millman J. Diagnosis of physical illness in psychiatric patients using axis III and a standardized medical history. Hosp Community Psychiatry. 1991 Apr;42(4):395–400. doi: 10.1176/ps.42.4.395. [DOI] [PubMed] [Google Scholar]
  6. Dickey B., Azeni H. Persons with dual diagnoses of substance abuse and major mental illness: their excess costs of psychiatric care. Am J Public Health. 1996 Jul;86(7):973–977. doi: 10.2105/ajph.86.7.973. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Donabedian A. The quality of care. How can it be assessed? JAMA. 1988 Sep 23;260(12):1743–1748. doi: 10.1001/jama.260.12.1743. [DOI] [PubMed] [Google Scholar]
  8. Drake R. E., Osher F. C., Wallach M. A. Alcohol use and abuse in schizophrenia. A prospective community study. J Nerv Ment Dis. 1989 Jul;177(7):408–414. doi: 10.1097/00005053-198907000-00004. [DOI] [PubMed] [Google Scholar]
  9. Einstadter D., Cebul R. D., Franta P. R. Effect of a nurse case manager on postdischarge follow-up. J Gen Intern Med. 1996 Nov;11(11):684–688. doi: 10.1007/BF02600160. [DOI] [PubMed] [Google Scholar]
  10. Elasy T., Crews C., Casper E., Mehler P. Primary care and mental illness. J Gen Intern Med. 1996 Jul;11(7):441–442. doi: 10.1007/BF02600197. [DOI] [PubMed] [Google Scholar]
  11. Elasy T., Crews C., Casper E., Mehler P. Primary care and mental illness. J Gen Intern Med. 1996 Jul;11(7):441–442. doi: 10.1007/BF02600197. [DOI] [PubMed] [Google Scholar]
  12. Farmer S. Medical problems of chronic patients in a community support program. Hosp Community Psychiatry. 1987 Jul;38(7):745–749. doi: 10.1176/ps.38.7.745. [DOI] [PubMed] [Google Scholar]
  13. Felker B., Yazel J. J., Short D. Mortality and medical comorbidity among psychiatric patients: a review. Psychiatr Serv. 1996 Dec;47(12):1356–1363. doi: 10.1176/ps.47.12.1356. [DOI] [PubMed] [Google Scholar]
  14. Goldberg R. J. Psychiatry and the practice of medicine: the need to integrate psychiatry into comprehensive medical care. South Med J. 1995 Mar;88(3):260–267. doi: 10.1097/00007611-199503000-00003. [DOI] [PubMed] [Google Scholar]
  15. Grob G. N. Mad, homeless, and unwanted. A history of the care of the chronic mentally ill in America. Psychiatr Clin North Am. 1994 Sep;17(3):541–558. [PubMed] [Google Scholar]
  16. Grumbach K., Keane D., Bindman A. Primary care and public emergency department overcrowding. Am J Public Health. 1993 Mar;83(3):372–378. doi: 10.2105/ajph.83.3.372. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Hayward R. A., Bernard A. M., Freeman H. E., Corey C. R. Regular source of ambulatory care and access to health services. Am J Public Health. 1991 Apr;81(4):434–438. doi: 10.2105/ajph.81.4.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hibbs J. R., Benner L., Klugman L., Spencer R., Macchia I., Mellinger A., Fife D. K. Mortality in a cohort of homeless adults in Philadelphia. N Engl J Med. 1994 Aug 4;331(5):304–309. doi: 10.1056/NEJM199408043310506. [DOI] [PubMed] [Google Scholar]
  19. Karasu T. B., Waltzman S. A., Lindenmayer J. P., Buckley P. J. The medical care of patients with psychiatric illness. Hosp Community Psychiatry. 1980 Jul;31(7):463–472. doi: 10.1176/ps.31.7.463. [DOI] [PubMed] [Google Scholar]
  20. Katon W., Von Korff M., Lin E., Walker E., Simon G. E., Bush T., Robinson P., Russo J. Collaborative management to achieve treatment guidelines. Impact on depression in primary care. JAMA. 1995 Apr 5;273(13):1026–1031. [PubMed] [Google Scholar]
  21. Koranyi E. K. Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinic population. Arch Gen Psychiatry. 1979 Apr;36(4):414–419. doi: 10.1001/archpsyc.1979.01780040056006. [DOI] [PubMed] [Google Scholar]
  22. Lazarus A. The role of primary care physicians in managed mental health care. Psychiatr Serv. 1995 Apr;46(4):343–345. doi: 10.1176/ps.46.4.343. [DOI] [PubMed] [Google Scholar]
  23. Maricle R. A., Hoffman W. F., Bloom J. D., Faulkner L. R., Keepers G. A. The prevalence and significance of medical illness among chronically mentally ill outpatients. Community Ment Health J. 1987 Summer;23(2):81–90. doi: 10.1007/BF00757162. [DOI] [PubMed] [Google Scholar]
  24. McCarrick A. K., Manderscheid R. W., Bertolucci D. E., Goldman H., Tessler R. C. Chronic medical problems in the chronic mentally ill. Hosp Community Psychiatry. 1986 Mar;37(3):289–291. doi: 10.1176/ps.37.3.289. [DOI] [PubMed] [Google Scholar]
  25. Mechanic D., Aiken L. H. Improving the care of patients with chronic mental illness. N Engl J Med. 1987 Dec 24;317(26):1634–1638. doi: 10.1056/NEJM198712243172605. [DOI] [PubMed] [Google Scholar]
  26. Novack D. H., Goldberg R. J. Psychiatric problems in primary care patients. J Gen Intern Med. 1996 Jan;11(1):56–57. doi: 10.1007/BF02603489. [DOI] [PubMed] [Google Scholar]
  27. Orleans C. T., George L. K., Houpt J. L., Brodie H. K. How primary care physicians treat psychiatric disorders: a national survey of family practitioners. Am J Psychiatry. 1985 Jan;142(1):52–57. doi: 10.1176/ajp.142.1.52. [DOI] [PubMed] [Google Scholar]
  28. Rask K. J., Williams M. V., Parker R. M., McNagny S. E. Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital. JAMA. 1994 Jun 22;271(24):1931–1933. [PubMed] [Google Scholar]
  29. Rosenheck R., Lam J. A. Homeless mentally ill clients' and providers' perceptions of service needs and clients' use of services. Psychiatr Serv. 1997 Mar;48(3):381–386. doi: 10.1176/ps.48.3.381. [DOI] [PubMed] [Google Scholar]
  30. Santos A. B., Henggeler S. W., Burns B. J., Arana G. W., Meisler N. Research on field-based services: models for reform in the delivery of mental health care to populations with complex clinical problems. Am J Psychiatry. 1995 Aug;152(8):1111–1123. doi: 10.1176/ajp.152.8.1111. [DOI] [PubMed] [Google Scholar]
  31. Shapiro S., Skinner E. A., Kessler L. G., Von Korff M., German P. S., Tischler G. L., Leaf P. J., Benham L., Cottler L., Regier D. A. Utilization of health and mental health services. Three Epidemiologic Catchment Area sites. Arch Gen Psychiatry. 1984 Oct;41(10):971–978. doi: 10.1001/archpsyc.1984.01790210053007. [DOI] [PubMed] [Google Scholar]
  32. Shea S., Misra D., Ehrlich M. H., Field L., Francis C. K. Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med. 1992 Sep 10;327(11):776–781. doi: 10.1056/NEJM199209103271107. [DOI] [PubMed] [Google Scholar]
  33. Sheline Y. I. High prevalence of physical illness in a geriatric psychiatric inpatient population. Gen Hosp Psychiatry. 1990 Nov;12(6):396–400. doi: 10.1016/0163-8343(90)90008-z. [DOI] [PubMed] [Google Scholar]
  34. Shore J. H. Psychiatry at a crossroad: our role in primary care. Am J Psychiatry. 1996 Nov;153(11):1398–1403. doi: 10.1176/ajp.153.11.1398. [DOI] [PubMed] [Google Scholar]
  35. Susser E., Valencia E., Conover S., Felix A., Tsai W. Y., Wyatt R. J. Preventing recurrent homelessness among mentally ill men: a "critical time" intervention after discharge from a shelter. Am J Public Health. 1997 Feb;87(2):256–262. doi: 10.2105/ajph.87.2.256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Torrey E. F. Jails and prisons--America's new mental hospitals. Am J Public Health. 1995 Dec;85(12):1611–1613. doi: 10.2105/ajph.85.12.1611. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Tsuang M. T., Perkins K., Simpson J. C. Physical diseases in schizophrenia and affective disorder. J Clin Psychiatry. 1983 Feb;44(2):42–46. [PubMed] [Google Scholar]
  38. Wasson J. H., Sauvigne A. E., Mogielnicki R. P., Frey W. G., Sox C. H., Gaudette C., Rockwell A. Continuity of outpatient medical care in elderly men. A randomized trial. JAMA. 1984 Nov 2;252(17):2413–2417. [PubMed] [Google Scholar]
  39. Wiener J. M. Encompassing diversity and demanding equity. Am J Psychiatry. 1995 Sep;152(9):1248–1251. doi: 10.1176/ajp.152.9.1248. [DOI] [PubMed] [Google Scholar]
  40. Williams R. M. The costs of visits to emergency departments. N Engl J Med. 1996 Mar 7;334(10):642–646. doi: 10.1056/NEJM199603073341007. [DOI] [PubMed] [Google Scholar]
  41. Young G. P., Wagner M. B., Kellermann A. L., Ellis J., Bouley D. Ambulatory visits to hospital emergency departments. Patterns and reasons for use. 24 Hours in the ED Study Group. JAMA. 1996 Aug 14;276(6):460–465. doi: 10.1001/jama.276.6.460. [DOI] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES