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Quality of Mental Health Care at a Student-Run Clinic: Care for the Uninsured Exceeds that of Publicly and Privately Insured Populations

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Abstract

Diagnosing and treating depression in a primary care practice is an important, yet difficult task, especially for safety-net practices serving the uninsured. In the United States healthcare system, there is a mismatch between the need for mental health care and access to services. This disparity is most striking among the uninsured. Mental health disorders are more prevalent among the uninsured, and even when diagnosed with mental illness, they are less likely to obtain necessary treatment than insured patients. Given the increasing burden of depression on society, growing numbers of uninsured and negative repercussions of untreated mental illness, improvements in screening and management protocols are becoming more important in primary care practices serving this population. The quality of depression treatment at commercial and public insurance plans in New York City (NYC) and New York State (NYS) were compared to that of the East Harlem Health Outreach Partnership (EHHOP), the student-run clinic of the Mount Sinai School of Medicine. Based on the comparison, the study made recommendations for an integrated, on-site mental health service program at the community health clinic. A cohort of 49 depressed patients were evaluated and treated at the EHHOP clinic. The quality of the mental health care was evaluated according to variables from the Healthcare Effectiveness Data and Information Set (HEDIS). Indicators of quality included demographics, method of diagnosis, type of pharmacological treatment, referral to specialty care, patient adherence to follow-up care and adherence to pharmacologic treatment. When compared to insured patients in NYS, more EHHOP patients had the appropriate number of physician contacts after being diagnosed with depression than patients with commercial health plans (P = 0.008) and Medicaid (P = 0.09). Similarly, a greater number of EHHOP patients had better acute phase (P = 0.001; P = 0.096) and continuous phase (P = 0.049; P = 0.88) pharmacologic treatment than patients with commercial health plans and Medicaid, respectively. EHHOP meets and, in some areas, exceeds the quality of depression treatment when compared to insured populations. Even though EHHOP already surpasses these indicators, the clinic can improve its diagnostic capabilities, prescription medication adherence, and referral care follow-through by creating an on-site mental health clinic.

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Notes

  1. Aetna, BSNENY, Blue Choice, CDPHP, CIGNA, Community Blue, Empire, GHI HMO Select, HIP, Health Net, Independent Health, MDNY, MVP, Oxford, Preferred Care, UnitedHealthCare of New York, Univera HealthCare, Upstate HMO.

  2. Affinity Health Plan, AmeriChoice, AmeriGroupCorp, Blue Choice Option, CDPHP, CenterCare, Community Blue, Fidelis Care New York, GHI HMO Select, HIP, Health Plus, HealthFirst PHSP, Inc., Hudson Health Plan, Independent Health's MediSource, MetroPlus, Neighborhood Health Providers, New York-Presbyterian CHP, Preferred Care, Suffolk Health Plan, Total Care, UnitedHealthCare of New York, Univera Community Health, WellCare of New York.

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Acknowledgments

The Patricia S. Levinson Fellowship in Research and the Mount Sinai Women’s Auxiliary Board provided financial support for this project.

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Authors and Affiliations

  1. Mount Sinai School of Medicine, Center for Advanced Medicine, One Gustave Levy Place, Box #1216, New York, NY, 10029, USA

    Kate M. Liberman, Yasmin S. Meah, Andrew Chow, Omayra Rolon & David C. Thomas

  2. Yale-New Haven Hospital Internal Medicine/Pediatrics Department, 20 York Street, New Haven, CT, 06510, USA

    Jeffrey Tornheim

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  1. Kate M. Liberman
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  2. Yasmin S. Meah
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Correspondence to Kate M. Liberman.

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Liberman, K.M., Meah, Y.S., Chow, A. et al. Quality of Mental Health Care at a Student-Run Clinic: Care for the Uninsured Exceeds that of Publicly and Privately Insured Populations. J Community Health 36, 733–740 (2011). https://doi.org/10.1007/s10900-011-9367-5

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  • DOI: https://doi.org/10.1007/s10900-011-9367-5

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