Impact of Community Mental Health-Based Integrated Care on Service Use Among Young Adults With Serious Mental Illness

People with serious mental illness (i.e., disabling psychotic, mood, and other disorders) develop chronic medical diseases early in life. This study aimed to examine the effects of integrating primary care into community mental health centers (CMHCs; reverse integrated care) on service use among young adults with serious mental illness who may benefit from early intervention.

This retrospective cohort analysis used Medicaid claims of 945 people with serious mental illness (ages 18-40) in CMHC care from 2020 to 2022-315 in reverse integrated care and 630 propensity score matched participants in comparison care (i.e., not reverse integrated care). Logistic regression, adjusted for participant characteristics, enrollment quarter, and past service use, assessed outcomes in the 6 months after enrollment.

Participants' mean±SD age was 32.56 ± 7.84 years; 29% had a diagnosis of schizophrenia, 40% had a co-occurring substance use disorder, 33% had a medical emergency department (ED) visit in the 6 months before enrollment, and all were enrolled in CMHC care at baseline. During follow-up, participants in reverse integrated care were more likely to have an outpatient medical visit (65% vs. 58%; adjusted odds ratio [AOR]=1.54, p=0.005) and were less likely to have a medical ED visit (26% vs. 33%; AOR=0.70, p=0.035) than those in comparison care.

Integrating primary care into CMHC services may increase access to outpatient medical care and reduce ED visits for medical reasons among young adults with serious mental illness. Future research should confirm these findings, assess longer-term outcomes, and examine implementation facilitators and barriers.