To end chronic homelessness related to illness and disability and prevent additional chronic homelessness, there is an urgent need for comprehensive and accessible health care.17,35 Collaborative mental health care models, integrating primary and specialist mental health care in the shelter setting, offer several advantages: they avoid long waiting lists for mental health services; they improve coordination of primary care and mental health services and integration of medical care with social work and other shelter-based services; they build on the strengths of the partners, relieving pressures from other parts of the health care system; and they promote academic medical linkages and community development.
Although collaborative care models have not been subjected to rigorous evaluation to determine their effectiveness, they are being widely adopted for diverse groups of patients. While a rigorous evaluation to establish our program's effectiveness has been undertaken, the program has received considerable praise from all stakeholders, including staff, clients, and community partners. All identified clients were treated in the shelter-based clinic, which eliminated referrals to specialty mental health services for treatment and the associated barriers. Shelter staff appreciated having easy access to specialty care, and the ability to retain primary care providers for clients. Clients appreciated being able to access culturally sensitive and flexible shelter-based services, since most had had negative experiences associated with mainstream service providers. Community partners identified the service as essential in eliminating service gaps and facilitating care coordination.
Program development is ongoing, focusing on strategies to promote treatment adherence. The high rates of treatment nonadherence found among our clients are consistent with previous reports of extensive nonadherence among patients with severe mental illness,36,37 and are associated with increased risk of relapse, hospitalization, and poor outcomes, including negative housing outcomes.38,39 A review of client treatment regimens revealed that injectable long-acting antipsychotics were underused, offered to only 3% (n = 2) of patients. Intensive multicomponent interventions may be needed to facilitate adherence and improve outcomes among these vulnerable individuals.
Emerging evidence suggests that shelter-based collaborative mental health care models are a possible alternative to traditional methods of providing mental health care to homeless persons who are mentally ill. In a health care system limited by scarce mental health resources, a collaborative effort that links physi- cal and mental health care and social services may be a possible solution to the complex health needs of this population.
Dickey B. Review of programs for persons who are homeless and mentally ill. Harvard Rev Psychiatry. 2000;8:242-250.
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FROM PHYSICIANS PRACTICE
Five Steps to Improving Patient Access Judy Capko,
May 21, 2013
Patient access is getting increased attention through reform initiatives. Here are five steps you can take to make sure patients get appropriate access to care in your office.
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