Improving Depression Care for Adults With Serious Mental Illness in Underresourced Areas: Community Coalitions Versus Technical Support

Abstract

Objective: Community Partners in Care (CPIC) was a group-randomized study of two approaches to implementing expanded collaborative depression care: Community Engagement and Planning (CEP), a coalition approach, and Resources for Services (RS), a technical assistance approach. Collaborative care networks in both arms involved health care and other agencies in five service sectors. This study examined six- and 12-month outcomes for CPIC participants with serious mental illness.

Methods: This secondary analysis focused on low-income CPIC participants from racial-ethnic minority groups with serious mental illness in underresourced Los Angeles communities (N=504). Serious mental illness was defined as self-reported severe depression (≥20 on the Patient Health Questionnaire-8) at baseline or a lifetime history of bipolar disorder or psychosis. Logistic and Poisson regression with multiple imputation and response weights, controlling for covariates, was used to model intervention effects.

Results: Among CPIC participants, 50% had serious mental illness. Among those with serious mental illness, CEP relative to RS reduced the likelihood of poor mental health-related quality of life (OR=.62, 95% CI=.41-.95) but not depression (primary outcomes); reduced the likelihood of having homelessness risk factors and behavioral health hospitalizations; increased the likelihood of mental wellness; reduced specialty mental health medication and counseling visits; and increased faith-based depression visits (each p<.05) at six months. There were no statistically significant 12-month effects.

Conclusions: Findings suggest that a coalition approach to implementing expanded collaborative depression care, compared with technical assistance to individual programs, may reduce short-term behavioral health hospitalizations and improve mental health-related quality of life and some social outcomes for adults with serious mental illness, although no evidence was found for long-term effects in this subsample.

Keywords: Collaborative care; Community mental health services; Community psychiatry; Serious mental illness; homelessness; public sector mental health; social determinants.

Figures

Figure 1. Trial profile

Footnotes: aAgency eligibility criteria: agencies had to provide services for adults or parents of child clients and be financially stable, i.e., not expecting to close during the study time period. Agencies were entities with administrative responsibilities bProgram eligibility criteria: programs had to serve at least 15 clients per week, have one or more staff, not focused on psychotic disorders or home services, and be willing to identify a staff liaison cWithin sectors, programs were matched on client size and smaller programs (faith-based, hair salons) were joined based on established relationships. Programs/clusters were randomized within communities, but a few unique programs were randomized across communities. We used a random number generator and CPIC Council members who provided seed numbers to initiate randomization. Randomization was overseen by a statistician not involved in recruitment.