Mental Illness: Families Cut Out Of Care

The statistics are startling: People with serious mental illness die, on average, 25 years earlier than the general population, according to a 2006 study published by the National Association of State Mental Health Program Directors Medical Directors Council. Suicide, perhaps surprisingly, is not the primary cause of death. While suicide and injury account for about 30 to 40 percent of these deaths, up to about 60 percent of premature deaths in persons with serious mental health are caused by common, chronic medical conditions, such as cardiovascular disease, diabetes and respiratory and infectious diseases such as asthma, HIV, hepatitis and tuberculosis.

According to the World Health Organization:

-- Mortality rates among people with schizophrenia are 2 to 2.5 times higher than the general population.

-- People with bipolar mood disorders have high mortality rates ranging from 35 percent higher to twice as high as the general population.

-- There is a 1.8 times higher risk of dying associated with depression.

One reason for this, the WHO says, is that people with severe mental illness do not receive the same quality of physical health care as the general population. The majority of these deaths are preventable, but these patients need more and better care for their physical problems. Integrating mental and physical health care could facilitate this, the organization says. And, in fact, it has, as a program in Missouri has shown.

[See: How to Find the Best Mental Health Professional for You.]

In 2012, Missouri created Community Mental Health Centers, or CMHCs, to act as health care homes for those with mental illnesses. These mental health centers added primary care providers and nurses to make sure that patients with mental illness also got treatment for their physical issues.

HbA1c levels -- measures of blood sugar in diabetics -- by 1.48 points. In addition, visits to the emergency room dropped by 32 percent, and those who did need hospitalization saw length of stays cut by 33 percent. During this period, Missouri's community mental health centers treated over 81,000 patients and the new model saved the state $98 million in health care costs." data-reactid="20">The results have been significant. In 2016, the Missouri Coalition for Community Behavioral Healthcare, which represents the state's community mental health centers, along with alcohol and addiction treatment and other organizations, reported that from 2012 to 2015 these primary care providers helped mental health patients lower blood cholesterol by 20 percent and HbA1c levels -- measures of blood sugar in diabetics -- by 1.48 points. In addition, visits to the emergency room dropped by 32 percent, and those who did need hospitalization saw length of stays cut by 33 percent. During this period, Missouri's community mental health centers treated over 81,000 patients and the new model saved the state $98 million in health care costs.

Home Is Where the Care Is

Health care homes, as defined in the Affordable Care Act, offer coordinated care to individuals with multiple chronic health conditions, including mental health and substance use disorders. This model has been taken up in primary care practices throughout the country, but not as readily in mental health centers, says Dr. Joe Parks, medical director of the National Council for Behavioral Health, which represents about 2,900 organizations that provide mental health or substance abuse services for about 10 million people nationwide. "Many patients see a mental health or substance abuse provider more often than a PCP," he says. "It makes sense to coordinate care through the provider that sees you most often and can help with more issues. This assumes that health care should be designed around the patient, rather than the convenience of the providers."

[See: Am I Just -- Sad or Actually Depressed?]

Parks was involved with getting the Missouri program off the ground, before the ACA turned the idea into a national action step. "We added nursing staff to our CMHCs and started bringing overall health into our [mental health] agencies," says Brent McGinty, president and CEO of the Missouri Coalition for Community Behavioral Healthcare, or MCCBH. It began with requiring metabolic screening for patients on certain psychotropic medications, then expanded in disease management for patients identified as high-cost Medicaid users. "We set this stage for moving into bringing the mind and body together," McGinty says. "When health care homes became an option under the ACA, the state moved quickly to build on that momentum. It has been really successful here. We are really proud of it."

Missouri has been so successful, it was one of eight states that the U.S. Department of Health and Human Services chose in 2017 to participate in a Certified Community Behavioral Health Clinic demonstration program under the Excellence in Mental Health Act of 2014. Minnesota, Nevada, New Jersey, New York, Oklahoma, Oregon and Pennsylvania were also chosen.

depression that needs addressing, other days it may be their diabetes."" data-reactid="28">But that success didn't come easily. "It was a culture shift, definitely," says Rachelle Glavin, director of clinical operations for the MCCBH. "The first step was to try it and help the staff understand what the conditions are and what to look out for." There was a small amount of pushback at first; "case managers would say, I didn't learn how to be a nurse," Glavin says. "But that wasn't what it was about. Integrating nurses with the team was important, and it was all about meeting the patient where they are. Some days it may be their depression that needs addressing, other days it may be their diabetes."

[Read: How to Help Someone Else Who Has Depression.]

Coaching for Those With Mental Illness

"The smart thing that Rachelle and Dr. Parks did was prepare a presentation why we were doing health care homes, and that these folks were dying 25 years earlier than the general population," McGinty says. "That made the CEOs [of those CMHCs] take ownership of it. Folks on the ground learned you don't have to be a nurse, but you do have to understand general wellness."

healthy lifestyle choices. They also sometimes get resistance from providers who don't know how to treat -- or don't want to treat -- those with mental illness." data-reactid="32">"We made sure to equip them with the resources and tools they needed," Glavin says. "Wellness coaching was a big initiative, and now we have changed the title 'case management' to wellness coaching." Mental health patients need that coaching more than other patients. They have a harder time scheduling and keeping appointments, taking their medications properly and making healthy lifestyle choices. They also sometimes get resistance from providers who don't know how to treat -- or don't want to treat -- those with mental illness.

lifesaving face-to-face interaction." data-reactid="33">"You're more likely to take your medicines and make lifestyle changes if you get to see a doctor face to face," Parks says. Bringing that doctor into the office that a mental health patient visits most often, as Missouri and other states have shown, may be the best way to facilitate that lifesaving face-to-face interaction.

David Levine is a freelance health reporter at U.S. News. He is a contributing writer for athenaInsight.com and Wainscot Health Media, a former health care columnist for Governing magazine and a regular contributor to many other health and wellness publications. He also writes about lifestyle and general interest topics, from history and business to beer and baseball, as a contributing writer for Westchester, Hudson Valley and 914INC magazines. His work has appeared in The New York Times, Sports Illustrated, American Heritage and dozens of other national publications, and he is the author or co-author of six books on sports. You can connect him on LinkedIn.

Source : https://www.yahoo.com/news/advantages-health-homes-mental-health-care-152326030.html

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