A novel collaborative practice model for treatment of mental illness in indigent and uninsured patients

The implementation and evaluation of a collaborative practice model (CPM) of mental health care at a free clinic are described.

Since 2004, the mental health clinic of the Cape Fear Clinic in Wilmington, NC, has provided pharmacotherapy and psychotherapy services to a mostly female population of poor and uninsured patients (average age, about 45 years) under a CPM that includes a state-licensed Clinical Pharmacist Practitioner with prescribing privileges. Spanish is the primary language of about 28% of the clinic's patients. At patient intake and (when possible) six months later, three measures of physical and mental health are administered: the Short-Form Health Survey (SF-12), the physical and mental component summaries of the Patient Health Questionnaire for depression (PHQ-9), and the Alcohol Use Disorders Identification Test (AUDIT); psychological counseling, psychotropic medications, and laboratory monitoring are provided as appropriate. In 2009, the clinic's volunteer health care providers served 56 patients (a total of 316 office visits), providing about 165 hours of free clinical services valued at more than $15,000 and free prescription medications valued at about $123,000. Although the clinic's experience has demonstrated the feasibility of CPM-based mental health care for the indigent and uninsured, a comparison of pretest and posttest data on a sample of clinic patients did not show significant changes from mean baseline SF-12, PHQ-9, and AUDIT scores, possibly due in large part to sampling challenges resulting from the loss of many clinic patients to follow-up.

A CPM that includes a pharmacist with prescribing authority and psychologists was implemented to provide care for a low-income, uninsured, partly Spanish-speaking patient population.