Improving Depression Care for Adults With Serious Mental Illness in Underresourced Areas: Community Coalitions Versus Technical Support
Open accessAbstract
OBJECTIVE: Community Partners in Care (CPIC) was a group-randomized study of two approaches to implementing expanded collaborative depression care: Community Engagement and Planning (CEP), a coalition approach, and Resources for Services (RS), a technical assistance approach. Collaborative care networks in both arms involved health care and other agencies in five service sectors. This study examined six- and 12-month outcomes for CPIC participants with serious mental illness. METHODS: This secondary analysis focused on low-income CPIC participants from racial-ethnic minority groups with serious mental illness in underresourced Los Angeles communities (N=504). Serious mental illness was defined as self-reported severe depression (≥20 on the Patient Health Questionnaire-8) at baseline or a lifetime history of bipolar disorder or psychosis. Logistic and Poisson regression with multiple imputation and response weights, controlling for covariates, was used to model intervention effects. RESULTS: Among CPIC participants, 50% had serious mental illness. Among those with serious mental illness, CEP relative to RS reduced the likelihood of poor mental health-related quality of life (OR=.62, 95% CI=.41-.95) but not depression (primary outcomes); reduced the likelihood of having homelessness risk factors and behavioral health hospitalizations; increased the likelihood of mental wellness; reduced specialty mental health medication and counseling visits; and increased faith-based depression visits (each p<.05) at six months. There were no statistically significant 12-month effects. CONCLUSIONS: Findings suggest that a coalition approach to implementing expanded collaborative depression care, compared with technical assistance to individual programs, may reduce short-term behavioral health hospitalizations and improve mental health-related quality of life and some social outcomes for adults with serious mental illness, although no evidence was found for long-term effects in this subsample.
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A community-based mental health program in the US comprising multidisciplinary care met the needs of adults with SMI, with significant improvements in health and wellbeing and reduced reliance on acute-based care.
“The findings revealed that the program met the needs of the sample because significant improvements were identified in participants' health and wellbeing outcomes, and their reliance on acute-based care was mitigated (Castillo et al. 2018).”
From Effect of community mental health care programs in Australia: A systematic review (2020) · cites this paper as Castillo et al. 2018
The Results (Intervention Effects; page unavailable) report significantly better mental health-related quality of life and mental wellness, and fewer behavioral health hospitalizations, for the coalition approach versus technical support at six months. The paper does not establish that the program broadly ‘met the needs’ of participants: the Discussion calls the findings exploratory, and the Results report no significant differences at 12 months. (LLM, conf=0.86)
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- Authors
- Castillo, E. G., Shaner, R., Tang, L., Chung, B., Jones, F., Whittington, Y., Miranda, J., & Wells, K. B.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- Psychiatric Services
- Published
- 2018-02-01
- Volume
- 69
- Issue
- 2
- Pages
- 195-203
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- PMC
- PMC5794612
- OpenAlex
- W2765150589
- Cited by
- 12
- References
- 34
- Citations by year
- 2024: 1 · 2021: 3 · 2020: 6 · 2019: 1 · 2018: 1
- FWCI
- 3.55
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Minority Health and Health Disparities (R01MD007721)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- severe mental illness, depression care, collaborative care, community coalitions, technical assistance, mental health-related quality of life, low-income adults, racial and ethnic minorities, bipolar disorder, psychosis
- MeSH terms
- Adult, Bipolar Disorder, Community Mental Health Services, Depressive Disorder, Female, Ill-Housed Persons, Hospitalization, Humans, Male, Middle Aged, Poverty, Psychiatric Status Rating Scales, Psychotic Disorders, Quality of Life, Los Angeles, Logistic Models, Medically Uninsured, Self Report
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