Table 3.

Models to Improve Health and Health Care for People with Serious Mental Illness

ModelDescriptionLimitationsSettingClinician Involvement
Dually trained physicians48,49,57Physician trained in both psychiatric and physical medicine manages all careFew available, may not maintain sufficient skills for complex medical care, may not be optimal use of resourcesHigh concentration of medical comorbidity, eg, inpatient and chemical-dependency treatment centersHigh
Physical medicine on-site consultation41,50Physical medicine clinician provides consultation and care within psychiatric clinic or inpatient settingExpensive unless volume is sufficient to fill consultant's scheduleConcentrated medical comorbidity, eg, inpatient and addiction centers or as outreach model for large clinics managing many SMI patients seen in limited number of psychiatric clinicsHigh
Collaborative care45,51,52Frequent communication between mental and physical health care teamsRequires un-reimbursed communication time, added attention to HIPAA compliance, and supportive communication infrastructure (eg, secure e-mail, telephone access, medical record access)Financially and administratively integrated systems with shared medical records, eg, HMOs and VA, co-located clinicsIntermediate
Case manager53,54Often a registered nurse who coordinates transportation and appointments, monitors health status and treatment adherenceTime intensive for nurse, potentially expensiveAny setting with sufficient volume of patientsLow
Facilitated referral to primary care55,56Psychiatric care team facilitates access to primary care teamRequires sufficient primary care access in communityPrivate clinics, geographically dispersed practice locationsIntermediate
  • SMI, serious mental illness; HIPAA, Health Insurance Portability and Accountability Act; HMO, health maintenance organization; VA, Veteran's Association.

  • Adapted and expanded from framework of Druss and Bower.50,58