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Current Research in Psychiatry

ISSN: 2768-3702

Literature Review Open Access
Volume 6 | Issue 1 | DOI: https://doi.org/10.46439/Psychiatry.6.045

Stewardship of psychiatric healthcare utilization: the role of systems-based, community-based, and individually-based factors

Joshua Baruth1,*, Magnolia Hammel2
  • 1Department of Psychiatry and Psychology, Mayo Clinic Health System, Rochester Minnesota, USA
  • 2Department of Psychology, University of Florida, Gainesville, Florida, USA
+ Affiliations - Affiliations

Corresponding Author

 Joshua Baruth, Baruth.Joshua@mayo.edu

Received Date: January 10, 2026

Accepted Date: February 17, 2026

Citation:

Baruth J, Hammel M. Stewardship of psychiatric healthcare utilization: the role of systems-based, community-based, and individually-based factors. Curr Res Psychiatry. 2026;6(1):9-31.


Copyright: © 2026 Baruth J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

As the demand for mental health care increases, acute care settings like emergency departments and inpatient psychiatric units have become overburdened. Intermediate levels of care and alternate treatment pathways are understudied and could efficiently utilize existing resources while also improving patient outcomes. This scoping review aims to identify common factors influencing community healthcare utilization to inform future research and development of novel or hybrid interventions. 
Ovid MEDLINE(R) (1946 to Present) was searched within Mayo Clinic libraries and a total of 36 articles were included: 3 clinical trials, 1 computer simulation, 1 cross sectional study, 2 meta-analyses, 5 observational studies, 1 prospective cohort study, 5 quasi-experimental studies, 9 randomized control trials, 6 retrospective cohort studies, and 3 review articles.
Several factors impacting rates of emergency department visits and inpatient hospital admissions for individuals with severe mental illness were identified. Access to specialized psychiatric care often within primary care settings allows for efficient triage into most appropriate treatment pathway. At the level of the healthcare-system hospital self-referral programs (SRIT), transitional discharge models (TDM), and home-based treatments have preliminary revealed promising results. Structured community-based programs like Assertive Community Treatment (ACT), Flexible Assertive Community Treatment (FACT), Community Based Mobile Crisis Services (CBMCS) and Crisis Response Teams (CRT) have been associated with reduced utilization and improved patient outcomes. Individual factors include patient autonomy, improved communication, opportunities for community engagement and inclusion of family / support system. 
There is not a “one-size-fits-all” approach but multiple, evidence-based pathways capable of increasing the likelihood of optimal patient outcomes and improved stewardship of community resources. Integrating aspects of these programs into hybrid models may prove beneficial for certain patient populations which should be explored as part of future research studies.

Keywords

Severe and persistent mental illness, Healthcare utilization, Community mental health services, Hospital admissions, Emergency department visits

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