Individuals with serious mental illness (SMI) have shortened life expectancies relative to the
general population to an extent that is not explained by unnatural causes such as suicide or
accidents. Numerous studies show higher rates of acute and chronic illnesses, lower quality
general medical care and worse outcomes in individuals with SMI. The issues that influence
general medical outcomes for individuals with SMI are complex and overlapping and likely
vary by disease state. Relevant factors can be categorized to include population characteristics,
contextual and system factors, provider factors, and community resources. Interventions aimed at
improving general medical outcomes in this population could be directed at any one, or several,
of these factors. The organization of service delivery for individuals with SMI may be the most
modifiable of the many factors that impact general medical outcomes in this population. In this
review, we sought to evaluate models of care designed to improve general medical outcomes
among individuals with SMI. We conducted a systematic review of the peer-reviewed literature
to answer the following key questions (KQs):
Three key questions (KQs) guided this systematic review:
Key Question #1: What types of care models have been evaluated prospectively that integrate mental
health care and primary medical care with the goal of improving general medical outcomes for
individuals with serious mental illness (SMI)?
Key Question #2: Do models of integrated care for individuals with SMI improve the process of care for
preventive services (e.g., colorectal cancer screening) and chronic disease management (e.g.,
annual eye examination in patients with diabetes mellitus [DM])?
Key Question #3: (3a) Do models of integrated care for individuals with SMI improve general functional
status outcomes (e.g., as measured by SF-36) or disease-specific functional status outcomes
(e.g., Seattle Angina Questionnaire) related to medical care for chronic medical conditions such
as DM, hypertension, or heart failure? (3b) Do models of integrated care for individuals with
SMI improve clinical outcomes related to preventive services (e.g., influenza rates) and chronic
medical care (e.g., kidney disease, amputations, retinopathy in patients with coexisting DM)?
Key Question #4: What are the gaps in evidence for determining how best to integrate care to improve
general medical outcomes for individuals with SMI?