Integrating behavioral healthcare for individuals with serious mental illness: A randomized controlled trial of a peer health navigator intervention Erin Kelly a,b, ⁎, Lei Duan a , Heather Cohen a , Holly Kiger a , Laura Pancake c , John Brekke a a School of Social Work, University of Southern California, 669 West 34th Street, Montgomery Ross Fisher Building, Los Angeles, CA 90089, USA b Health Services Research Center, University of California, Los Angeles, Los Angeles, CA 90023, USA c Pacific Clinics, 2550 E. Foothill Blvd., Pasadena, CA 91107, USA abstract article info Article history: Received 13 June 2016 Received in revised form 17 October 2016 Accepted 19 October 2016 Available online 25 October 2016 Objective: Individuals with serious mental illness also have high rates of comorbid physical health issues. To ad- dress those issues, this population needs interventions that improve self-management of health and healthcare. Methods: In order to improve the health and healthcare of individuals with serious mental illnesses, 151 con- sumers with serious mental illness were randomized to receive either usual mental healthcare plus the Bridge intervention (n = 76) or usual mental healthcare while on a 6 month waitlist (n = 75). The waitlist group re- ceived the intervention after the waitlist period. Results: Change score comparisons (difference of differences) of the treatment vs the waitlist groups revealed that the treated group showed significantly greater improvement in access and use of primary care health ser- vices, higher quality of the consumer-physician relationship, decreased preference for emergency, urgent care, or avoiding health services and increased preference for primary care clinics, improved detection of chronic health conditions, reductions in pain, and increased confidence in consumer self-management of healthcare. Conclusions: Peer providers using a manualized intervention can be an important part of the efforts to address the general medical care of individuals with serious mental illnesses. © 2016 Elsevier B.V. All rights reserved. Keywords: Integrated health care Serious mental illness Intervention Peer 1. Introduction The physical health of individuals with serious mental illnesses is se- verely compromised. Across systematic reviews, there is evidence that individuals with a serious mental illness (SMI) are dying about 10– 20 years before their non-mentally ill peers (Chesney et al., 2014; De Hert et al., 2011; Walker et al., 2015). There are many reasons for this early mortality but largely it is due to preventable and treatable physical health conditions that are more prevalent and under-treated in this population. Individuals with SMI have higher rates of multiple chronic health conditions, such as diabetes, high blood pressure, high cholester- ol, obesity, viral hepatitis, chronic obstructive pulmonary diseases, and cancer (Weber et al., 2009). These conditions are critical to address not only due to reduced quality of life and early mortality but because the cost of care for chronic conditions is also increasing rapidly. In 2002, treatment of chronic conditions cost approximately $331.9 billion but by 2013, costs had nearly doubled to $623.8 billion (Mandros, 2016). The higher rates of these conditions among this population are partly attributable to poor healthcare and lifestyle habits, but largely result from taking psychoactive medications and disparities in healthcare on system, provider, and patient levels (De Hert et al., 2011). It is critical to address the medical care factors that impair effective treatment of the physical health of individuals with SMI. There are nu- merous strategies that are being employed to coordinate the care of this population but only a few include self-management by consumers as a critical ingredient in their interventions (Kelly et al., 2014a). Across these many care integration models (Gerrity, 2016), an activated pa- tient who can navigate a productive relationship with care providers is necessary. The “Bridge” is a comprehensive, healthcare engagement and self- management intervention that teaches participants the skills to im- prove healthcare access and use. Our intervention is guided by Gelberg et al.’s (2000) Model for Vulnerable Populations, which in- cludes the multitude of factors that can suppress or facilitate healthcare service use among those with SMI. The Bridge intervention has been de- scribed in detail previously (Brekke et al., 2013; Kelly et al., 2014b). Briefly, “the Bridge” intervention targets factors that negatively impact healthcare access, utilization, and outcomes among individuals with SMI. Consumers are taught the skills to access and manage their healthcare effectively by mental health peers known as peer health nav- igators. Peers are individuals who use their lived experience with Schizophrenia Research 182 (2017) 135–141 ⁎ Corresponding author. E-mail address: kellyeri@usc.edu (E. Kelly). http://dx.doi.org/10.1016/j.schres.2016.10.031 0920-9964/© 2016 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres