Psy-Q: Why might a Behavioral Health Home be most effective in managing serious mental illness (SMI)? Karl Johnson answers.

Karl Johnson, Researcher

Karl Johnson, Researcher

Answer: A recent study led by Karl Johnson found that adults with serious mental illness (SMI) who enrolled in a behavioral health home (BHH) program attended more primary care visits while also reducing their ER and behavioral outpatient visits. The BHH program examined in the study integrated primary care into a specialty outpatient behavioral health setting. Johnson – a PhD student at Gillings School of Global Public Health at UNC, Chapel Hill – and his team followed adults with SMI for 3.5 years. They examined healthcare service utilization and cardiometabolic assessments to understand how BHH enrollment might help to eliminate the 20- to 30-year mortality gap faced by people with SMI.

Johnson discussed the findings with Psycom Pro:

SMI and Primary Care

Psycom Pro: Can you talk about why it is important for people with SMI to have greater access to primary care through BHH enrollment?

Johnson: The disparity in mortality (a tragic 20- to 30-year gap) between those with SMI and those without is in large part driven by disparities in physical health outcomes that can be routinely addressed by primary care providers. However, individuals with psychiatric disorders have, on average, 50% less odds of consistently accessing a primary care physician (more on primary care and mental health follow-up).

Colocation of primary care within outpatient mental health settings, along with healthcare personnel to help bridge the gap between the two services, is a small step toward enabling greater access to primary care among those with psychiatric disorders.

SMI and Cardiometabolic Measures

Psycom Pro: When looking at cardiometabolic measures in your study, why do you think there was an improvement in the hemoglobin A1c tests but not the LDL cholesterol tests among people who participated in BHH?

Johnson: It is unclear why there was an improvement in hemoglobin A1c tests but not the LDL cholesterol tests among people who participated in BHH. One hypothesis is that a relatively high percentage (~20%) of the BHH enrollee population were diabetic. For these patients and their healthcare providers, the strategies to address hemoglobin A1c may have been more well-known and more easily implemented than strategies to address LDL cholesterol.

However, it’s important to note that, at least qualitatively, the number of visits was higher for both LDL and A1c screening for BHH patients compared to controls in both the pre- and post- periods. Perhaps, if the timeline of this analysis were extended (say, to 5 years or 10 years), we would detect a difference in LDL cholesterol levels as well.

SMI Research Gaps

Psycom Pro: Building off of your team’s findings, what areas should future research target to better understand how to close the 20- to 30-year mortality gap faced by adults with SMI?

Johnson: As determined by our study, while overall BHH enrollees experienced greater primary care utilization than their non-BHH peers, this gain was noticeably smaller among non-white enrollees and non-native English speakers. The benefits of BHHs must be equally ensured across all patient groups who participate.

Future research – ideally, qualitative analyses of enrollee and non-enrollee experiences – should identify how barriers to accessing the benefits of BHHs differ across racial, socioeconomic, and linguistic minorities and how additional programmatic features can be developed to ensure equitable access.

See additional perspectives on SMI and behavioral health.

Last Updated: Sep 9, 2021