Community Mental Health Journal

, Volume 50, Issue 4, pp 435–446 | Cite as

A Pilot Test of a Peer Navigator Intervention for Improving the Health of Individuals with Serious Mental Illness

  • Erin KellyEmail author
  • Anthony Fulginiti
  • Rohini Pahwa
  • Louise Tallen
  • Lei Duan
  • John S. Brekke
Original Paper


Individuals with serious mental illness (SMI) are at considerably higher risk for morbidity and mortality than those in the general population. The current pilot trial is a preliminary examination of a peer health navigation intervention for improving health and healthcare utilization called the Bridge. Twenty-four individuals with SMI were randomly assigned to either peer navigation or treatment as usual (TAU). Navigators encouraged development of self-management of healthcare through a series of psychoeducation and behavioral strategies. Outcomes included a range of health consequences, as well as health utilization indices. After 6 months, compared to the TAU group, participants receiving the intervention experienced fewer pain and health symptoms. Participants changed their orientation about seeking care to a primary care provider (44.4 % vs. 83.3 %, χ2 = 3.50, p < .05) rather than the emergency room (55.6 % vs. 0 %, χ2 = 8.75, p < .01). Therefore, the Bridge intervention demonstrated considerable promise through positively impacting health and healthcare utilization.


Serious mental illness Navigation Integrated care Intervention 



Funded with support from the UniHealth Foundation, the Los Angeles Basin Clinical Translational Science Institute at the University of Southern California, the Clinical Translational Science Institute at the University of California, Los Angeles, and the Los Angeles County Department of Mental Health.


  1. Anderson, G., & Knickman, J. R. (2001). Changing the chronic care system to meet people’s needs. Health Affairs, 20, 146–160.PubMedCrossRefGoogle Scholar
  2. Andrusyna, T. P., Tang, T. Z., DeRubeis, R. J., & Luborsky, L. (2001). The factor structure of the working alliance inventory in cognitive-behavioral therapy. The Journal of Psychotherapy Practice and Research, 10, 173–178.PubMedCentralPubMedGoogle Scholar
  3. Ara, R., & Brazier, J. (2008). Predicting the Short Form-6D preference-based index using the eight mean short form-36 health dimension scores: Estimating preference-based health-related utilities when patient level data are not available. Value in Health, 12, 346–353.PubMedCrossRefGoogle Scholar
  4. Bair, M., Robinson, R., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity. Archives of Internal Medicine, 163, 2433–2445.PubMedCrossRefGoogle Scholar
  5. Bazelon Center for Mental Health Law. (2004). Get it together. How to integrate physical and mental health care for people with serious mental disorders. Washington DC.Google Scholar
  6. Borenstein, M. (1997). Hypothesis testing and effect size estimation in clinical trials. Annals of Allergy, Asthma & Immunology, 78, 5–16.CrossRefGoogle Scholar
  7. Bradford, J. B., Coleman, S., & Cunningham, W. (2007). HIV system navigation: An emerging model to improve HIV care access. AIDS patient care and STDs, 21, S49–S58.PubMedGoogle Scholar
  8. Brekke, J., Phillips, E., Pancake, L., O, A., Lewis, J., & Duke, J. (2010). Implementation practice and implementation research: A report from the field. Research on Social Work Practice, 19, 592–601.CrossRefGoogle Scholar
  9. Brekke, J., Raine, A., Ansel, M., Lencz, T., & Bird, L. (1997). Neuropsychological and psychophysiological correlates of psychosocial functioning in schizophrenia. Schizophrenia Bulletin, 23, 19–28.PubMedCrossRefGoogle Scholar
  10. Brekke, J., Siantz, E., Pahwa, R., Kelly, E., Tallen, L., & Fulginiti, A. (2013). Reducing health disparities for people with serious mental illness: Development and feasibility of a peer health navigation intervention. Best Practices in Mental Health, 9, 62–82.Google Scholar
  11. Brunero, S., & Lamont, S. (2010). Health behaviour beliefs and physical health risk factors for cardiovascular disease in an outpatient sample of consumers with a severe mental illness: A cross-sectional survey. International Journal of Nursing, 47, 753–760.CrossRefGoogle Scholar
  12. Carpinello, S. E., Knight, E. L., Markowitz, F. E., & Pease, E. A. (2000). The development of the mental health confidence scale: A measure of self-efficacy in individuals diagnosed with mental disorders. Psychiatric Rehabilitation Journal, 23, 236–243.CrossRefGoogle Scholar
  13. Chang, C. K., Hayes, R., Broadbent, M., Fernandes, A., Lee, W., Hotopf, M., et al. (2010). All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: A cohort study. Biomedical Central Psychiatry, 10, 77–84.CrossRefGoogle Scholar
  14. Cramer, J. A., & Rosenheck, R. (1998). Compliance with medication regimens for mental and physical disorders. Psychiatric Services, 49, 196–201.PubMedGoogle Scholar
  15. Dalmau, A., Bergman, B., & Brismar, B. (1997). Somatic morbidity in schizophrenia—a case control study. Public Health, 111, 393–397.PubMedCrossRefGoogle Scholar
  16. Darnell, J. S. (2007). Patient navigation: A call to action. Social Work, 52, 81–84.PubMedCrossRefGoogle Scholar
  17. Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D., & Tebes, J. (1999). Peer support among individuals with severe mental illness: A review of the evidence. Clinical Psychology: Science and Practice, 6, 165–187.Google Scholar
  18. Davidson, L., Chinman, M., Sells, D., & Rowe, M. (2006). Peer support among adults with serious mental illness: A report from the field. Schizophrenia Bulletin, 32, 443–450.PubMedCentralPubMedCrossRefGoogle Scholar
  19. De Hert, M., Correll, C. U., Bobes, J., Cetkovich-Bakmas, M., Cohen, D., Asai, I., et al. (2011). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry, 10, 52–77.Google Scholar
  20. Deakin, B., Ferrier, N., Holt, R. I. G., et al. (2010). The physical health challenges in patients with severe mental illness: cardiovascular and metabolic risks. Journal of Psychopharmacology, 24, 1–8.CrossRefGoogle Scholar
  21. Dickerson, F. B., Brown, C. H., Daumit, G. L., Lijuan, F., Goldberg, R. W., Wohlheiter, K., et al. (2006). Health status of individuals with serious mental illness. Schizophrenia Bulletin, 32, 584–589.PubMedCentralPubMedCrossRefGoogle Scholar
  22. Dixon, L., Postrado, L., Delahanty, J., Fischer, P., & Lehman, A. (1999). The association of medical comorbidity in schizophrenia with poor physical and mental health. Journal of Nervous and Mental Disorders, 187, 496–502.CrossRefGoogle Scholar
  23. Dohan, D., & Schrag, D. (2005). Using navigators to improve care of underserved patient. Cancer, 104, 848–855.PubMedCrossRefGoogle Scholar
  24. Druss, B. G., Rask, K., & Katon, W. J. (2008). Major depression, depression treatment and quality of primary medical care. General Hospital Psychiatry, 30, 20–25.PubMedCentralPubMedCrossRefGoogle Scholar
  25. Druss, B. G., von Esenwein, S. A., Compton, M. T., Rask, K. J., Zhao, L., & Parker, R. M. (2010a). A randomized trial of medical care management for community mental health settings: the primary care access, referral, and evaluation (PCARE) study. American Journal of Psychiatry, 167, 151–159.PubMedCentralPubMedCrossRefGoogle Scholar
  26. Druss, B. G., Zhao, L., von Esenwein, S. A., Bona, J. R., Fricks, L., Jenkins-Tucker, S., et al. (2010b). The health and recovery peer (HARP) program: A peer-led intervention to improve medical self-management for person with serious mental illness. Schizophrenia Research, 118, 264–270.PubMedCentralPubMedCrossRefGoogle Scholar
  27. Eisen, S. V., Wilcox, M., Leff, H. S., Schaefer, E., & Culhane, M. A. (1999). Assessing behavioral health outcomes in outpatient programs: Reliability and validity of BASIS-32. The Journal of Behavioral Health Services & Research, 26, 5–17.CrossRefGoogle Scholar
  28. Felton, C., Stastny, P., Shern, D., Blanch, A., Donahue, S., Knight, E., et al. (1995). Consumers as peer specialists on intensive case management teams: Impact on client outcomes. Psychiatric Services, 46, 1037–1044.PubMedGoogle Scholar
  29. Filik, R., Sipos, A., Kehoe, P. G., Burns, T., Cooper, S. J., Stevens, H., et al. (2006). The cardiovascular and respiratory health of people with schizophrenia. Acta Psychiatrica Scandinavica, 113, 298–305.PubMedCrossRefGoogle Scholar
  30. Fischer, M., Stedman, M., Lii, J., Vogeli, C., Shrank, W., Brookhart, M. A., et al. (2010). Primary medication non-adherence: Analysis of 195,930 electronic prescriptions. Journal of General Internal Medicine, 25, 284–290.PubMedCentralPubMedCrossRefGoogle Scholar
  31. Gates, L., & Akabas, S. (2007). Developing strategies to integrate peer providers into the staff of mental health agencies. Administrative Policy of Mental Health and Mental Health Services Research, 34, 293–306.CrossRefGoogle Scholar
  32. Gelberg, L., Andersen, R. M., & Leake, B. D. (2000). The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Services Research, 34, 1273–1302.PubMedCentralPubMedGoogle Scholar
  33. Gilmer, T., Stefancic, A., Ettner, S., Manning, W., & Tsemberis, S. (2010). Effect of full-service partnerships on homelessness, use and costs of mental health services, and quality of life among adults with serious mental illness. Archives of General Psychiatry, 67, 645–652.PubMedCrossRefGoogle Scholar
  34. Goldberg, R. J. (1999). Financial incentives influencing the integration of mental health care and primary care. Psychiatric Services, 50, 1071–1075.PubMedGoogle Scholar
  35. Griswold, K. S., Pastore, P. A., Homish, G. G., & Leonard, K. E. (2010). A randomized trial: Are care navigators effective in connecting patients to primary care after psychiatric crisis? Community Mental Health Journal, 46, 398–402.PubMedCrossRefGoogle Scholar
  36. Hackman, A. L., Goldberg, R. W., Brown, C. H., Fang, L., Dickerson, F., Wohlheiter, K., et al. (2006). Use of emergency department services for somatic reasons by people with serious mental illness. Psychiatric Services, 57, 563–566.PubMedCrossRefGoogle Scholar
  37. Horvitz-Lennon, M., Kilbourne, A. M., & Pincus, H. A. (2006). From silos to bridges: meeting the general health care needs of people with mental illness. Health Affairs, 25, 659–669.PubMedCrossRefGoogle Scholar
  38. Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington, DC: National Academies Press.Google Scholar
  39. Kelly, G. R., & Scott, J. E. (1990). Medication compliance and health education among outpatients with chronic mental disorders. Medical Care, 28, 1181–1197.PubMedCrossRefGoogle Scholar
  40. Kilbourne, A. M., Irmiter, C., Capobianco, J., Reynolds, K., Milner, K., Barry, K., et al. (2008). Improving integrated general medical and mental health services in community-based practices. Administration and Policy in Mental Health and Mental Health Services Research, 35, 337–345.PubMedCrossRefGoogle Scholar
  41. Krugg, S. E. (1999). Access and use of emergency services: inappropriate use versus unmet need. Clinical Pediatric Emergency Medicine, 1, 35–44.CrossRefGoogle Scholar
  42. Lacro, J. P., Dunn, L. B., Dolder, C. R., Leckband, S. G., & Jeste, D. V. (2002). Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: A comprehensive review of recent literature. Journal of Clinical Psychiatry, 63, 892–909.PubMedCrossRefGoogle Scholar
  43. Lawn, S., Battersby, M., Pols, R. G., Lawerence, J., Parry, T., & Urukalo, M. (2007). The mental health expert patient: Findings from a pilot study of a generic chronic condition self-management programme for people with mental illness. International Journal of Social Psychiatry, 53, 63–74.PubMedCrossRefGoogle Scholar
  44. Lester, H. E., Tritter, J. Q., & Sorohan, H. (2005). Providing primary care for people with serious mental illness: a focus group study. British Medical Journal, 330, 1122–1128.PubMedCentralPubMedCrossRefGoogle Scholar
  45. Lieberman, A. A., & Coburn, A. F. (1986). The health of the chronically mentally ill: A review of the literature. Community Mental Health Journal, 22, 104–116.PubMedCrossRefGoogle Scholar
  46. Osborn, D., Levy, G., Nazareth, I., Petersen, I., Islam, A., & King, M. (2007). Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom’s general practice research database. Archives of General Psychiatry, 64, 242–249.PubMedCrossRefGoogle Scholar
  47. Parker, V. A., & Lemak, C. H. (2011). Navigating patient navigation: Crossing health services research and clinical boundaries. In J. D. Blair & M. D. Fottler (Eds.), Biennial review of health care management (Advances in Health Care Management, Vol. 11) (pp. 149–183). England: Emerald Group Publishing Limited.CrossRefGoogle Scholar
  48. Parks, J., Svendsen, D., Singer, P., & Foti, M. E. (2006). Morbidity and mortality in people with serious mental illness. Report from the National Association of State Mental Health Program Directors.Google Scholar
  49. Pedersen, A., & Hack, T. (2010). Pilots of oncology health care: A concept analysis of the patient navigator role. Oncology Nursing Forum, 37, 55–60.PubMedCrossRefGoogle Scholar
  50. President’s New Freedom Commission on Mental Illness. (2003). Interim report of the president’s new freedom commission on mental health. Washington, DC: US Federal Government.Google Scholar
  51. Rosenick, S. G., & Rosenheck, R. A. (2008). Integrating peer-provided services: A quasi-experimental study of recovery orientation, confidence, and empowerment. Psychiatric Services, 59, 1307–1314.CrossRefGoogle Scholar
  52. Simpson, E. L., & House, A. O. (2002). Involving users in the delivery and evaluation of mental health services: systemic review. British Medical Journal, 325, 1265–1270.PubMedCentralPubMedCrossRefGoogle Scholar
  53. Solomon, P. (2004). Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27, 392–401.PubMedCrossRefGoogle Scholar
  54. Tyrance, P, Jr, Himmelstein, D., & Woolhandler, S. (1996). US emergency department costs: No emergency. American Journal of Public Health, 86, 1527–1531.PubMedCentralPubMedCrossRefGoogle Scholar
  55. Weinick, R., Zuvekas, S., & Cohen, J. W. (2000). Racial and ethnic differences in access to and use of health care services, 1977 to 1996. Medical Care Research and Review, 57, 36–54.PubMedCrossRefGoogle Scholar
  56. Wells, K. J., Battaglia, T., Dudley, D., Garcia, R., Greene, A., Calhoun, E., et al. (2008). Patient navigation: state of the art, or is it a science? Cancer, 113, 1999–2010.PubMedCentralPubMedCrossRefGoogle Scholar
  57. World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Erin Kelly
    • 1
    Email author
  • Anthony Fulginiti
    • 2
  • Rohini Pahwa
    • 2
  • Louise Tallen
    • 2
  • Lei Duan
    • 2
  • John S. Brekke
    • 2
  1. 1.Health Services Research CenterUniversity of California-Los AngelesLos AngelesUSA
  2. 2.School of Social WorkUniversity of Southern CaliforniaLos AngelesUSA

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