Exploring health service use among mental health consumers

Background: People living with serious mental illness (SMI) have shortened life expectancies compared to the general population, largely due to poorly managed chronic care conditions.  The Affordable Care Act is improving access to care for this population by integrating physical and mental health services.  Whether health homes for mental health consumers would be most accessible in primary care or mental health settings is unclear.  This study uses the Four-Quadrant Clinical Integration Model to identify factors associated with accessing physical health services from primary care or mental health settings among a sample of mental health consumers. Methods Data were drawn from a large-scale assessment of client reported outcomes in San Diego County Adult and Older Adult Mental Health Services (N=712). Multinomial logistic regression identified factors associated with use of health services from a mental health provider, a primary care provider, both a primary care and mental health provider, or neither type of provider. Results:  Low self-rated emotional health was associated with decreased odds of accessing all service options: (Primary health provider OR=0.42;95%CI=0.24-0.73; mental health provider OR=0.36;95%CI=0.19-0.69; both physical and mental health provider OR=0.32;95%CI=0.19-0.56). Having chronic conditions was associated with increased likelihood of accessing a primary provider (OR=2.61;95%CI=1.36-4.97) and both a primary and mental health provider (OR=2.00;95%CI=1.04-3.87). Discussion: Consumers with poorly rated emotional health require enhanced engagement into health care.  Care coordination could be enhanced for consumers with multiple chronic conditions through health navigation and and other forms of peer support. Other factors to consider when planning health homes will be discussed.