How is care for people with serious mental illnesses structured and paid for in other countries? What can the US learn from those models?

The United States’ unique blend of employer-sponsored health insurance, high number of specialists, and state-funded mental health public sector has created a unique system of delivering and paying for services for those with serious mental illness (SMI). Most other developed countries such as the UK and Canada rely on primary care providers to provide the bulk of care for people with SMI, and pay for them through universal, publicly-financed health insurance. Providing care for people with SMI in general health settings could potentially reduce financial barriers to care and improve coordination between primary care and speciality mental health services. In contrast, the specialty-centered US system could potentially provide greater access to specialists and to evidence-based services developed for populations with SMI. However, there is very limited cross-national data comparing access, quality, and outcomes of care for people with serious mental illness across these different systems.


Ramanuj P et al. Carrots and Sticks on Opposite Sides of the Atlantic: Integration Incentives for People With Serious Mental Illness in England. Psychiatr Serv. 2017 May 1;68(5):430-432.

Schneider E. et al. Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care. Commonwealth Fund, 2018.

  • Was this Helpful ?
  • YesNo

Join our #MissionForBetter now

Sign up for our newsletter. We’ll let you know about new resources, education, and more.