Nonpsychiatric Outpatient Care for Adults With Serious Mental Illness in California: Who Is Being Left Behind?

Although primary care is associated with better outcomes, many individuals with serious mental illness do not receive general medical services. This study examined patient-level factors associated with not having outpatient general medical visits among individuals with serious mental illness in California.

The study analyzed administrative, pharmacy, and billing data for 56,895 Medicaid-enrolled adults with serious mental illness treated in community mental health clinics between October 1, 2010, and September 20, 2011. Poisson regression estimated independent associations between predictor variables and outpatient general medical visits.

One-third of participants (34%) had no outpatient general medical visits during the study. In multivariate analyses, younger adults (ages 18–27) were less likely than older groups to have such a visit (adjusted relative risk [ARR]=1.07 and 1.19, respectively, for ages 28–47 and 48–67). Women were more likely than men to have such a visit (ARR=1.29). Compared with whites, blacks were less likely to have an outpatient general medical visit (ARR=.93). Rural dwellers were less likely than urban dwellers to have such a visit (ARR=.64). Persons with drug or alcohol use disorders were less likely than those without such disorders to have an outpatient general medical visit (ARR=.95), and those with schizophrenia were less likely than those with any other psychiatric disorder examined to have such a visit.

Individuals with serious mental illness had low use of outpatient general medical services. Integrated care models are needed to engage these individuals and eliminate disparities in morbidity and mortality.