ORIGINAL PAPER A Randomized Trial: Are Care Navigators Effective in Connecting Patients to Primary Care after Psychiatric Crisis? Kim S. Griswold • Gregory G. Homish • Patricia A. Pastore • Kenneth E. Leonard Received: 1 December 2009 / Accepted: 17 February 2010 / Published online: 5 March 2010 Ó Springer Science+Business Media, LLC 2010 Abstract Persons with serious mental illnesses suffer excess medical morbidity compared to the general popu- lation. This RCT aimed to determine whether navigators are effective in helping patients connect to primary care after psychiatric crisis. Adults presenting for emergency care were randomly assigned to a navigator versus usual care. Navigators facilitated access to primary care. Out- comes were connection rates to medical care and the impact of health insurance, hospitalization and mental health care on primary care attendance. After 1 year, the intervention group was statistically more likely to access care, versus controls (62.4 vs. 37.6%, P \ .001). Naviga- tors were effective in helping patients connect to primary care after a psychiatric crisis. Improved access to primary care is important given the complex chronic health prob- lems of this vulnerable cohort. Keywords Psychiatric crisis Á Primary care Á Health care navigation Introduction Persons with serious mental illnesses, such as the Axis I psychotic, mood and anxiety disorders, suffer excess medical morbidity and mortality compared to the general population (Brown et al. 2000; Green et al. 2003; Lambert et al. 2003). Earlier mortality occurs from cardiovascular causes due to higher prevalence rates of diabetes type II and hypertension in adults with serious mental illness when compared to the general population (Morbidity and Mor- tality in People with Serious Mental Illness 2006). The medications used to treat patients with these disorders contribute to obesity, diabetes, and metabolic disorders. In particular, the use of atypical antipsychotics has been implicated as an important contribution to these risks (Reist et al. 2007). Finally, the excess in morbidity and mortality is also due to difficulties in accessing medical care, and to the lack of communication between systems managing mental, behavioral and physical health (Emergency Response 2005; Griswold et al. 2008). This issue is all the more critical given the poor health behaviours and risks associated with antipsychotic medications that characterize many of these patients. Whether because of system, patient or provider issues, individuals with serious mental illnesses not linked to primary care nor receiving needed medical services can suffer negative health, emotional and social consequences, and incur increased health care costs by inappropriate utilization of emergent care. For adults with serious mental illness, improved access to primary care and a ‘‘medical home’’ could help to mitigate emergency room use, as well as provide the opportunity for appropriate medical assessment and intervention. The medical home provides patients with care coordination and continuity, an on-going relationship with one provider, and a team- K. S. Griswold (&) Á P. A. Pastore Department of Family Medicine, Primary Care Research Institute, The State University of New York at Buffalo, 462 Grider Street, SUNY Clinical Center, Buffalo, NY 14215, USA e-mail: griswol@buffalo.edu G. G. Homish Department of Health Behavior School of Public Health and Health Professions, The State University of New York at Buffalo, Buffalo, NY 14214, USA K. E. Leonard Research Institute on Addictions, Buffalo, NY 14201, USA 123 Community Ment Health J (2010) 46:398–402 DOI 10.1007/s10597-010-9300-x