Implementing the Chronic Care Model of Mental Health in Primary Care: The Mental Healthcare Improvement Project (MHIP)

Due to a shortage of affordable mental health care, primary care physicians (PCPs) are frequently responsible for the care of mental illness. These physicians, nonetheless, are not often adequately prepared to make accurate diagnoses or appropriate treatment plans. In community settings that have few means, mental health resources are often unavailable or require extraordinary effort to coordinate. The Mental Healthcare Improvement Project (MHIP) instituted a model of interdisciplinary depression care at the Jefferson Reaves (JR) clinic, a public primary care center in inner-city Miami, FL. This process involved conversion of a disease management program originally developed for people with third party reimbursement and functioning managed care systems into a system for use in a resource-poor environment with diverse disenfranchised ethnic groups (African Americans and Spanish-speaking immigrants). We attempted to reduce the symptoms of depression of our patients through the use of PCP education and training, care management at the Primary Care Center (PCC) for patients with mental illness, limited MH consultation on-site at the PCC, outreach to develop relationships with community mental health and social service resources, and engagement with health and mental health systems leadership in the process of systems change. The MHIP engaged the patients in an active and collaborative management of their care. Patients who have extremely limited resources demonstrated significant improvements in symptoms of severe depression and increased self-efficacy. Fifty percent of faculty and residents demonstrated competency in depression screening, assessment, and appropriate referral compared to a baseline assessment of zero percent.