Background: The purpose of this study is to determine whether integrated or enhanced referral models of care result in greater access to mental health evaluation and treatment for older primary care patients with depression, anxiety, or at-risk alcohol use.
Methods: Ten sites were involved in the randomized longitudinal PRISMe (Primary Care Research in Substance Abuse and Mental Health for Elderly) study. Over 2200 primary care patients over age 65 with depression, anxiety disorder, or at-risk drinking were randomized either to:
(1) an integrated model consisting of a mental health provider located within the primary care setting or
(2) an enhanced referral model of specialty mental health care.
Results: Most participants were between age 65 and 74, were of male gender, and over half were Caucasian. Nearly half were married and over two-thirds lived with one or more persons. Nearly equal numbers had either at-risk alcohol use or a mental health problem, significantly fewer had dual diagnosis (both psychiatric condition and at-risk alcohol use). Overall, the integrated care model resulted in greater engagement (defined as access to an initial evaluation by a mental health provider) than the enhanced referral model of care. This finding was repeated in subgroup analyses, showing that individuals with at-risk drinking alone, with a mental health diagnosis alone, or with dual diagnoses exhibited greater engagement within the integrated treatment than within the enhanced referral condition. The greatest difference between integrated and referral models was for at-risk alcohol use.
Conclusions: Integrated mental health and substance abuse services in primary care settings are associated with greater engagement in treatment by older persons compared to optimized referral specialty mental health clinics. Implications of these findings will be discussed with respect to health policy and implications for mental health service delivery to older persons.
The sponsor of this study includes SAMHSA, the Veteran’s Administration, and HRSA. There are no conflicts of interest reported.
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