Mind the Gap - Developing an Integrated Behavioral Health Home to Address Health Disparities in Serious Mental Illness

Aug 26, 2026

Uploaded by Quinn

Study evaluates an integrated behavioral health home (BHH) pilot for adults with psychotic and bipolar disorders in a safety-net setting. Quasi-experimental comparison uses electronic health records to contrast outcomes before versus after implementation across 424 BHH patients and 1,521 non-enrolled individuals matched by propensity score. Results show fewer total psychiatric hospitalizations and fewer emergency visits, with no differences in medical hospitalizations; HbA1c screening increases while lipid monitoring and metabolic changes show no significant differences. Findings support care integration to reduce acute psychiatric utilization and strengthen evidence for wider dissemination.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Objective

Intervention and study population

Methods

Study design and data sources

Matching and weighting approach

Results

Psychiatric hospitalizations and emergency visits

Medical admissions and monitoring outcomes

Conclusions

Implications for care integration

This article addresses the Core Competency of Systems-Based Practice ARTICLES Mind the Gap: Developing an Integrated Behavioral Health Home to Address Health Disparities in Serious Mental Illness Miriam C. Tepper, M. D., Alexander M. Cohen, M. S.W., M. P. H., Ana M. Progovac, Ph. D., Andrea Ault-Brutus, Ph. D., H. Stephen Leff, Ph. D., Brian Mullin, B. S., Carrie M. Cunningham, M. D., M. P. H., Benjamin Lê Cook, Ph. D., M. P. H. Objective: This study evaluated the impact of an integrated behavioral health home (BHH) pilot on adults with psychotic and bipolar disorders. Methods: Quasi-experimental methods were used to compare outcomes before (September 2014–August 2015) and after the intervention (September 2015–August 2016) among ambulatory BHH patients and a control group. Electronic health records were compared between 424 BHH patients (N=369, psychotic disorder; N=55, bipolar disorder) and 1,521 individuals from the same urban, safety-net health system who were not enrolled in the BHH. Groups were weighted by propensity score on the basis of sex, age, raceethnicity, language, 2010 U. S. Census block group characteristics, Medicare and Medicaid enrollment, and diabetes diagnosis. Results: BHH patients had fewer total psychiatric hospitalizations and fewer total emergency visits compared with the control group, a difference that was predominantly driven by patients with at least one psychiatric hospitalization or ED visit. There were no differences in medical hospitalizations. Although BHH patients were more likely to receive HbA1c screening, there were no differences between the groups in lipid monitoring. Regarding secondary outcomes, there were no signiﬁcant differences in changes in metabolic monitoring parameters among patients with diabetes. Conclusions: Participation in a pilot ambulatory BHH program among patients with psychotic and bipolar disorders was associated with signiﬁcant reductions in ED visits and psychiatric hospitalizations and increased HbA1c monitoring. This evaluation builds on prior research by specifying intervention details and the clinical target population, strengthening the evidence base for care integration to support further program dissemination. Psychiatric Services 2017; 68:1217–1224; [doi: 10.1176/appi.ps.201700063](doi: 10.1176/appi.ps.201700063) Millions of adults in the United States experience a schizophrenia-spectrum or bipolar disorder during their lifetime, with estimated prevalence of 1.2%(1) and 2.1%(2), respectively. Individuals with serious mental illness in the United States die 20 to 30 years earlier than the general population (3–5), primarily due to medical conditions such as chronic obstructive pulmonary disease, pneumonia orinﬂuenza, lung cancer, diabetes, and cardiovascular disease (6,7) . Despite having high rates of chronic conditions (8), nearly 41% of persons with serious mental illness report unmet needs for general medical treatment (9) . These physical comorbidities emerge because of multiple factors, including unhealthy behaviors (such as tobacco use, physical inactivity, and poor diet), iatrogenic effects of antipsychotic medications, and social adversity (10–12) . Inadequate primary care utilization may drive poor health outcomes for persons with serious mental illness. In the United States, adults with schizophrenia are 45% less likely and adults with bipolar disorder are 26% less likely to have a primary care physician compared with persons without mental disorders (13) . Even when people with serious mental illnesses access primary care, they frequently receive lower-quality care than the general population (14–18) . Interventions that incorporate behavioral health services into primary care generally improve health care access for patients with milder mental health needs (19), but they largely do not reach people with serious mental illness, who often view mental health specialists, not primary care providers (PCPs), as their usual so

FAQs

What does the integrated behavioral health home (BHH) pilot aim to do for adults with serious mental illness?

The BHH pilot aims to integrate behavioral and medical care through enhanced access, care coordination, care transition support, and health promotion. The evaluation targets adults with psychotic and bipolar disorders to improve service use and preventive monitoring outcomes.

How were outcomes compared in the study?

Quasi-experimental methods compared outcomes before (September 2014–August 2015) and after the intervention (September 2015–August 2016). Electronic health records were contrasted between 424 BHH patients and 1,521 individuals not enrolled, with groups weighted by propensity score on demographic, language, enrollment, and diabetes-related characteristics.

What were the main findings after participating in the BHH pilot?

BHH participation was associated with fewer total psychiatric hospitalizations and fewer emergency visits compared with the control group. Medical hospitalizations showed no differences, HbA1c screening was more likely, and lipid monitoring and diabetes-related metabolic monitoring changes did not differ significantly.

Aug 26, 2026

Uploaded by Quinn