Can People Who Have Experience with Serious Mental Illness Help Peers Manage Their Health Care?

This project has results

Abstracts

Public Abstract

Download this abstract: English (pdf) | Español (pdf) | Audio Recording (mp3)

What was the research about?

Serious mental illnesses, such as bipolar disorder, schizophrenia, or major depression, can affect a person’s mood, thinking, and behavior. These illnesses often last a long time and can disrupt people’s lives. People with serious mental illness die 10 to 30 years younger than people who don’t have mental illness, often from health problems that could have been treated or prevented. People with serious mental illness may find it hard to find doctors who understand them. They may also find it hard to follow plans for preventing or treating diseases.

The research team wanted to help people with serious mental illness better manage their health and health care. To do so, the team used a peer navigator program. A peer navigator is someone who has experience with mental illness. Peer navigators help people with serious mental illness get the care they need. The research team compared patients in the peer navigator program with those who received usual mental health care.

What were the results?

The research team found that patients in the program started to see their regular doctors more often, were more satisfied with their doctors, and preferred outpatient care over urgent care more than those who weren’t in the program. Patients in the program also had less severe pain, learned more about health problems they already had, and became more confident that they could manage their health care than those who weren’t in the program.

Compared with usual care, the program didn’t improve patients’ mental health, social skills, or health habits.

Who was in the study?

The study included 151 patients with serious mental illness who received care at a large mental health center in California. The average patient age was 47, and 54 percent of patients were women. Sixty percent of patients in the study were Hispanic or Latino, 25 percent were white, 8 percent were African American, and 8 percent were other or mixed race.

What did the research team do?

The research team compared two groups of patients. Both received usual mental health care. The research team assigned about half of the patients by chance to the peer navigator program. These patients received peer navigation services for six months. They worked with peer navigators to make a healthcare plan and set health goals. Peer navigators also helped patients set appointments, went with patients to see their doctors, and coached patients on skills for managing health care.

What were the limits of the study?

The study took place in a single mental health center in California. The results might be different in other places. Also, the study was not large enough to see if the program worked differently for certain groups of people, such as for women or men.

Future research could see if certain parts of the program are more helpful than other parts.

How can people use the results?

Clinics that treat people with serious mental illness could consider offering a peer navigation program like the one in this study.

Professional Abstract

Objective

To assess whether Bridge, a peer-navigation program created to help patients with serious mental illness to access and use healthcare services, improves self-management of health and health care

Study Design

Design Element	Description
Design	Randomized controlled trial
Population	151 people with serious mental illness
Interventions/ Comparators	Peer health navigation (Bridge program) Usual care
Outcomes	Primary: patient-reported measures of health-service use, preference for outpatient care, health status, self-management Secondary: mental health and functioning, health habits, social functioning
Timeframe	6-month follow-up for primary outcome

This study was a randomized controlled trial of Bridge, a six-month peer-health-navigation program for people with serious mental illness.

The study included 151 people with serious mental illness who received care at a large community mental health agency in Southern California. Each patient had a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, or major depression. The average age of patients was 47, and 54% of patients were women. A majority of patients were Hispanic/Latino (60%). The rest were white (25%), African American (8%), and other or mixed race (8%).

Researchers randomly assigned patients to one of two groups. Those in the intervention group received their usual mental health care plus help from a peer health navigator who had experience with mental illness. Patients worked with health navigators to make a healthcare plan and set health goals. Health navigators also helped patients set appointments, went with patients to healthcare appointments, and coached patients on health-management skills. Patients in the control group received usual mental health care. Researchers compared study outcomes before and after treatment for the intervention and control groups.

Results

Compared with the control group, the intervention group showed significantly greater improvement in health service use, primary care doctor relationship quality, preference for outpatient care, and self-management confidence (all p<0.05). Patients in the intervention group also had greater improvements in pain severity and chronic disease detection through health screening (both p<0.05).

The study did not find significant differences between the two groups in changes in scores for self-management behaviors, mental health and functioning, health habits, or social functioning. However, participants in the intervention group did show improvement in self-management behaviors and reduced use of emergency room visits six months after the intervention ended.

Limitations

The study took place in a single community mental health agency in Southern California; findings may be different in other settings or locations. Also, the relatively small sample size limited the research team’s ability to conduct analyses on subpopulations, which may have limited the team’s ability to detect changes in some outcomes.

Conclusions and Relevance

The team found that the Bridge program helped address the physical health and healthcare needs of people with serious mental illness, but did not address their social and mental health functioning needs.

Future Research Needs

Future research could examine whether certain features of the intervention lead to improvements in study outcomes.

This project's final research report is expected to be available by January 2019.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also confirms that the research has followed PCORI’s Methodology Standards. During peer review, experts who were not members of the research team read a draft report of the research. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. Reviewers do not have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve how the research team analyzed its results or reported its conclusions. Learn more about PCORI’s peer-review process here.

In response to peer review, the PI made changes including

Justifying the inclusion of a large number of measures in the study to evaluate study outcomes by citing the lack of “gold standard” measures for individuals with serious mental illness. The investigators further explained inconsistencies between the outcomes reported in the final report and those listed in their ClinicalTrials.gov record
Completing sensitivity analyses comparing study outcomes with and without imputing values for missing data. The investigators initially justified the lack of imputation, despite the high attrition rate, by stating that their final sample size still met power estimates. The results from imputing study outcomes did not differ from the originally reported analyses
Explaining the rationale for comparing the 6-month scores for the waitlist control group to the 6-month scores for the intervention group. The reviewers were concerned that the 6-month scores for the waitlist group might be contaminated with information about the intervention, so the researchers also compared the waitlist baseline scores with the 6-month intervention scores, and reported the differences in a footnote

Conflict of Interest Disclosures

View the COI disclosure form.

Journal Articles

Schizophrenia Research

Integrating behavioral healthcare for individuals with serious mental illness: A randomized controlled trial of a peer health navigator intervention

More on this Project

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Research to Help People with Serious Mental Illnesses Improve Their Health
People with serious mental illnesses often struggle to receive care to address common chronic physical health problems. Several PCORI-funded research projects are testing ways to help people with serious mental illness get the physical health care they need.

Project Details

Principal Investigator

John Sinclair Brekke, PhD, MS

Project Status

Completed; PCORI Public and Professional Abstracts Posted

Project Title

Peer Health Navigation: Reducing Disparities in Health Outcomes for the Seriously Mentally Ill

Board Approval Date

September 2013

Project End Date

December 2017

Organization

University of Southern California

Year Awarded

2013

State

California

Year Completed

2018

Project Type

Research Project

Funding Announcement

Addressing Disparities

Conditions

Mental/Behavioral Health

Depression

Schizophrenia and Psychotic Disorders

Serious Mental Illness

Project Budget

$1,289,032

Study Registration Information

HSRP20143388

NCT02022462

Page Last Updated:

October 9, 2018