Results Summary

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.

Final Research Report

View this project's final research report.

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

Project Information

John Sinclair Brekke, PhD, MS
University of Southern California
$1,289,032
10.25302/4.2019.AD.13046650
Peer Health Navigation: Reducing Disparities in Health Outcomes for the Seriously Mentally Ill

Key Dates

September 2013
December 2017
2013
2018

Study Registration Information

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Last updated: November 30, 2022