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Unmet Need for Mental Health and Addictions Care in Urban Community Health Clinics: Frontline Provider Accounts

Ms. Cristofalo, Ms. Bumgardner, Dr. Zatzick, and Dr. Roy-Byrne are affiliated with the Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP) and the Department of Psychiatry, University of Washington School of Medicine at Harborview Medical Center, Seattle. Dr. Boutain is with the Department of Psychosocial and Community Health, and Mr. Schraufnagel is with the Department of Psychology, University of Washington, Seattle. Send correspondence to Dr. Roy-Byrne, CHAMMP, University of Washington School of Medicine at Harborview Medical Center, 325 9th Ave., Box 359911, Seattle, WA 98104-2499 (e-mail: roybyrne{at}u.washington.edu).

OBJECTIVE: To facilitate planning to improve care delivery in community health clinics, this study provides an in-depth description of the social, cultural, and organizational factors that create the context for mental health and addictions treatment delivery in this setting. METHODS: Seventeen community health clinic providers and personnel were interviewed for 45–90 minutes with open-ended questions to elicit the context of their frontline provider experiences. Major themes and subthemes of responses were identified with content analysis. RESULTS: Issues that create significant barriers to care included complex patient comorbidity and demographic characteristics; clinic organization, resources, and funding shortfalls; communication barriers with specialty mental health and addictions agencies; and stigmatizing aspects of mental health, addictions, and disadvantaged status. CONCLUSIONS: The unique barriers to care in the community health care setting, as well as the unique characteristics of patients served, are likely to require context-specific solutions. These solutions will determine the viability of existing chronic disease management models, such as collaborative care, when applied to this setting.

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