The Importance of Follow-Up Care for Mental Illness

Date: 07/08/25

Visiting the hospital for mental illness or intentional self-harm can be overwhelming. Research suggests that timely follow-up care after discharge can help the member transition back to home, work, or school and can help providers detect early post-hospitalization reactions and medication concerns.¹

Advancements in integrating behavioral healthcare with primary care have created opportunities with the Psychiatric Collaborative Care Model. With this model, non-behavioral health providers can utilize a psychiatric consultant to participate in care services.

Provider Tips

Offer telehealth and phone visits. Provide empathic listening and nonjudgmental discussions to engage the patient and caregivers in decision making. Reach out proactively to assist in (re)scheduling appointments within the required timeframes. Encourage coordination of care between physical and behavioral health providers, including transitions in care.

Reinforce the treatment plan and evaluate any medication regimen considering presence/absence of side effects, etc. Partner with the health plan to address social determinants, health equity, and quality care. Provide timely submission of claims and code-related diagnoses and visits correctly. Address co-morbidities and integrate care with peer support and psychiatric collaborative care models.

Measures

• Follow-Up After Hospitalization for Mental Illness (FUH)
• Follow-Up After Emergency Department Visit for Mental Illness (FUM)

Additional Support:

• Substance Abuse and Mental Health Service Administration
• National Alliance on Mental Illness
• SMI Adviser, A Clinical Support System for Serious Mental Illness
• Collaborative Care Model

Source: NCQA