Treatment of serious mental illness in medical and mental health settings

Objective: This study investigated service use by individuals with serious and nonserious mental illness receiving mental health care in medical and mental health settings. Methods: Claims data from the New York State Medicaid Data Warehouse were examined for 8,988 patients who received at least one mental health service at an urban academic medical center during 2017 at a mental health setting, a medical setting, or both. Results: Most patients (59%) received all of their mental health care in medical settings and from unaffiliated providers, including a large portion (16%) with serious mental illness. Despite the availability of integrated care in the medical setting and use of unaffiliated mental health providers, rates of mental health inpatient admissions were high among all patients in this setting (including those with serious and with nonserious mental illness), considerably higher than for patients treated in a mental health clinic within the system. Rates of medical and substance abuse inpatient admissions were also much higher for patients treated in the medical setting and by unaffiliated providers, compared with those treated in the system's mental health clinics. Conclusions: Findings suggest that when mental health services are available in medical and mental health settings within the same system, either patients with more severe physical illnesses are more likely to receive their mental health care in medical settings and from unaffiliated providers and thus have more hospitalizations of all types or affiliated mental health settings more effectively address clinical needs and thus reduce hospitalizations.