title: Quality of mental health care at a student-run clinic: care for the uninsured exceeds that of publicly and privately insured populations.
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.
authors.affiliation: Mount Sinai School of Medicine, Center for Advanced Medicine, New York, NY 10029, USA. Kate.Liberman@mssm.edu
authors.forename: Kate M
authors.initials: KM
authors.lastname: Liberman
authors.forename: Yasmin S
authors.initials: YS
authors.lastname: Meah
authors.forename: Andrew
authors.initials: A
authors.lastname: Chow
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Tornheim
authors.forename: Omayra
authors.initials: O
authors.lastname: Rolon
authors.forename: David C
authors.initials: DC
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003863:Depression / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D009518:New York; D009519:New York City; D011787:Quality of Health Care; D013337:Students, Medical; D014481:United States; D055815:Young Adult