Can People Who Have Experience with Serious Mental Illness Help Peers Manage Their Health Care? [Internet]

Excerpt

Background: The physical health of individuals with serious mental illness is severely compromised. Consistent evidence shows that individuals with a serious mental illness have higher rates of morbidity for common health conditions compared with those of people who are not mentally ill, and they are dying 10 to 30 years before their non–mentally ill peers. This early mortality is largely due to preventable and treatable physical health conditions in this population.

Objective: To address the disparity in early mortality rates, the population with serious mental illness needs interventions that improve self-management of health and health care. The Bridge is a comprehensive health care engagement and self-management intervention that teaches outpatient mental health participants the skills they need to improve their access to and use of health care. The intervention lasts approximately 6 months and is delivered by trained mental health peers. It is manualized and uses motivational and behavioral strategies as well as psychoeducation to activate and engage participants in their health and health care. The intervention is delivered primarily in the community settings in which participants receive physical health services.

Methods: Participants were recruited from a large community mental health agency in Southern California that did not provide onsite primary health care. A total of 151 consumers with serious mental illness were randomized to receive either usual mental health care plus the Bridge intervention (n = 76) or usual mental health care while on a 6-month waitlist (n = 75). The waitlist group received the intervention after 6 months. The mean age of the sample was 46.9 years old; the gender balance was roughly equal (54% female). Race/ethnicity was Hispanic/Latino (60%), Caucasian (25%), African American (8%), and other/mixed race (7%).

Data were collected in 3 waves, with 6-month intervals between assessments. Change score comparisons were conducted for baseline (pretreatment) to 6 months (posttreatment) for the treated vs usual care group. Direct primary outcomes included use of routine health care services, use of emergency and urgent care services, preferred locus of health care, global satisfaction with health care, quality of relationship with primary care provider, attitudes about health care self-management, and self-management behaviors. Indirect primary outcomes included health screenings, detection of undiagnosed medical conditions, global health rating, health symptoms, pain levels, physical health medications, and interference with daily activities. Secondary outcomes included mental health and functional status, use of psychiatric medication, health habits, internalized and provider stigma, and life satisfaction.

Results: The 6-month attrition rate was 18.5%; 123 subjects participated in the 6-month posttreatment assessment. In terms of outcomes, change score comparisons (difference of differences) of the treatment vs the waitlist group revealed that the former showed significantly greater improvement in the primary outcomes of access to and use of primary care health services, decreased preference for emergency or urgent care or avoiding health services altogether, increased preference for primary care clinics, higher-quality relationship with the primary care provider, improved detection of medical conditions, reductions in pain, and increased confidence in self-management of health care. No significant changes were found in number of health screenings, number of health symptoms, use of emergency/urgent care services, satisfaction with health care, interference with daily activities, behaviors of self-management, or in the secondary outcomes for the treated group in comparison with the waitlist group.

The gains in the immediate intervention group had not significantly declined at 6 months after the end of the intervention. In fact, 2 indicators reflected further improvement: members of this group reported significantly fewer emergency room/urgent care visits and significantly more behavioral self-management than they had immediately after the intervention. After both groups (immediate treatment and waitlist) had completed the intervention, we combined the effects and found statistically significant improvements from pretreatment on most of the primary outcomes and some secondary outcomes.

Conclusions: The Bridge intervention is a promising peer-delivered intervention to address the physical health and health care needs of individuals with serious mental illness. Future work should optimize this intervention so that its effects can be improved.