Primary Medical Care Access Barriers and Experiences of People with Mental Illness: A Pilot Study from the Perspective of Care Coordinators

Research finds that persons with serious mental illness (SMI) experience higher rates of chronic health conditions than the overall population, and these are thought to contribute to a shorter average lifespan. Explanations for poorer health outcomes include structural factors, and provider and patient behaviors that result in delays seeking care and/or failure to obtain needed care. Various solutions are being proposed to facilitate better health care for persons with SMI. This paper reports on a survey undertaken by a case management agency as its first step in a wider study of barriers and facilitators of quality primary health care. Source of care, barriers to, and experiences with primary care is reported for 96 persons with SMI by their intensive care coordinators. Ninety-three percent had a primary care provider, but only 71% used that provider as the usual source of care. Care coordinators identified the three persons on their caseloads with the most serious chronic health problems, and rated the importance of factors in a primary care visit. They reported providers were respectful, listened, and provided patients an opportunity to speak for themselves, but they perceived patient behaviors associated with mental illness affected the ability to participate in care and attend to health and wellness. The results raise questions: (1) would patients perceive the interactions similarly and (2) does the perception of interfering patient behaviors (by care coordinators and/or providers) affect the quality of care received? These will be the focus of future work.