People with chronic mental disorders may be at risk of reduced access to medical treatment and poor quality of medical care. The authors examined receipt of and barriers to medical treatment among patients at a community mental health center. Fifty-nine patients completed a validated instrument for measuring access to medical care and the quality of primary care. Their responses indicated problems with access to care, and their scores were significantly lower than those of the general population on all four domains used to assess the quality of primary medical care. The findings suggest the need for community mental health centers to better assess and address barriers to primary medical care.

Better general medical care, transparency of reporting, and commitment of fiscal resources to clinical care predicted better mental health care performance for U.S. HMOs.

The large and consistent association between mental health volume and performance suggests parallels with the medical and surgical literature. As with that previous literature, further work is needed to better understand the mechanisms underlying this association and the potential implications for using volume as a criterion in plan choice.

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Mental health studies frequently involve multifaceted psychosocial interventions. It may be difficult to isolate the active ingredients that make these interventions successful. This study examined the use of qualitative methods to better understand the content of one of these interventions and to help elucidate the links between the care process and health outcomes. A series of five focus groups were convened at a site remote from a model primary care clinic for veterans. Transcripts of the focus groups were analyzed to identify themes and categorize results for patients with serious mental disorders. Three themes emerged from the groups: the difficulty patients had previously faced in obtaining medical care, the flexibility and availability of resources that defined the clinic culture, and organizational restructuring that allowed enhanced communication. Qualitative methods can be a useful means of "unpacking" multifaceted mental health services interventions. These methods may make it possible to refine and disseminate these models more widely.