Sharon Hix and Brenda Jeffers regularly come to a Dalton day program for people with mental illness.
Each has medical problems in addition to mental health issues. Hix, 65, is pre-diabetic, has high cholesterol and a thyroid problem. Jeffers, 52, is battling a cholesterol problem and attempting to beat her smoking habit. Both women are trying to exercise more and eat healthier.
Their mental health services are delivered in a building that will soon offer medical care as well. Hix and Jeffers, and others like them, will be able to get both kinds of care under one roof. Ideally, that will mean overall care that is better coordinated.
Their Dalton mental health service organization, and a local community health center, are among 93 programs nationally that have won a federal grant intended to improve the “whole health’’ of a person with behavioral health problems.
The trend to merge care for the brain and for the rest of the body has taken off in Georgia, thanks to collaborations between two segments of the safety net: community service boards and community health centers.
Under this integrated model, people with mental illness, who often let their physical ailments go untended, get immediate access to primary care. And many patients who enter the system with medical complaints are diagnosed and treated for depression and other behavioral health problems.
Some behavioral health patients have not seen a primary care doctor in 10 years, says Frank Berry, commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities.
Before being chosen as commissioner, Berry ran a community service board in suburban Atlanta, which created sites in Lawrenceville and Conyers that combined mental and physical health care.
This type of mental/physical health collaboration “is going to provide better outcomes,’’ Berry says. And it will reduce costs by addressing a patient’s needs earlier.
This integration of services seeks to address a longstanding problem: Individuals with severe and persistent mental illness die 25 years earlier than the general population.
These deaths are often the result of largely preventable physical problems — such as tobacco addiction and related illnesses, as well as obesity and diabetes. People with serious mental illness often “don’t exercise, have very unhealthy lifestyles,’’ says Dr. John Bartlett of the Carter Center’s Mental Health Program.
Psychotropic drugs often lead to weight gain, experts say.
Highland Rivers Health, the public behavioral health provider in Dalton, and the local federally qualified health center, Georgia Mountains Health, were recently awarded a four-year, $1.6 million federal grant to improve the care of adults with mental illness who also have diabetes, cardiovascular disease or hypertension.
The money from the Substance Abuse and Mental Health Services Administration (SAMHSA) will help “bring together the mind and the body,’’ says Jason Bearden, CEO of Highland Rivers. The grant will also allow mobile care in vans that will reach nearby rural areas Murray, Gilmer and Fannin counties.
Bearden says of those with serious mental illness at Highland Rivers, up to 90 percent have significant physical issues as well, including high rates of obesity, diabetes, and smoking.
Poverty is a problem for large numbers of people with mental illness. Many don’t get medical help, says Natalie Davis of Dalton, who has fought major depression and now works as a certified peer specialist, trained to assist people with mental illness in their recovery. Many people with mental illness “can’t afford the healthy foods,’’ she adds.
Hope in a hard-hit area
Integration of care will start in early 2013 in Dalton, the northwest Georgia city that’s called the “Carpet Capital of the World’’ but has fallen on hard times since the economic downturn began.
The housing and building slump cut carpet sales drastically, and Dalton suffered the third-worst employment drop of America’s 372 metro areas in 2011, according to government figures.
Dalton’s unemployment rate in October of this year was 11.2 percent, much higher than the state average.
The area has a large homeless population, says Steven Miracle, executive director of Georgia Mountains Health.
People here with mental illness tend to cycle in and out of emergency rooms, jails and homeless shelters. Prescription drug abuse and methamphetamine use are major problems, Miracle says.
The new Dalton program will be a one-stop shop. A primary care physician will be posted at a Highland Rivers behavioral health location. The community health center will do preliminary mental health screenings of its medical patients. Children and teenagers with mental health issues will eventually come to the same center that houses the health clinic.
This integration of care is part of the movement toward what are known as patient-centered medical homes.
A medical home is a single practice or facility that provides as much of a patient’s overall care as possible. “We’re trying to take care of every issue they have,’’ says Duane Kavka, executive director of the Georgia Association for Primary Health Care, which represents community health centers.
Georgia, he says, “is a little ahead of the curve’’ nationally in the move toward integrated care.
The effort in Georgia got a jump start through the Carter Center’s Mental Health Program, which brought together community service boards and health centers from the same geographic areas in a series of meetings beginning two years ago.
The goal was to help facilitate new relationships between safety net providers of physical health and behavioral health, says Bartlett of the Carter Center, who hosted the meetings. He says there are now 20 such partnerships across the state.
The coordination can improve care no matter where the patient enters the system, either from the physical or mental health side, Bartlett says.
He also points out that many people visiting a doctor for physical health needs often have their behavioral health needs unrecognized in the rush of a 15-minute medical appointment. “It’s not a setting that’s designed to address behavioral health.’’ Bartlett says.
And he adds, ”people who are depressed and/or have problem drinking or drugging have worse clinical and financial outcomes for their medical conditions.’’
Integration aims to reinvent primary care to address the whole person through a team approach, he says.
Trend felt in several parts of state
In coastal Georgia, where the Gateway community service board partnered with a health center, behavioral services and medical care are delivered together at three Savannah sites.
“What we’re trying to do is provide treatment for the whole person,’’ says Frank Bonati, CEO of Gateway. State funding has helped in this effort, Bonati adds.
Berry, the commissioner of Behavioral Health and Developmental Disabilities, told GHN that he is working with his counterpart at Community Health, David Cook, on getting technical assistance on these integration efforts from the National Council for Behavioral Health.
Dalton is the third area in the state to get a SAMHSA grant, after Columbus and Cobb/Douglas.
The Cobb and Douglas community services boards, through a four-year, $2 million grant with West End Medical Centers, has installed nurse practitioners and nurses in an outpatient mental health centers in Austell. Patients have access to fitness experts and peer specialists as well.
The collaborative has seen more than 600 patients, and has more than 430 active clients. Peer specialists encourage people with mental illness to get medical care and adopt wellness practices, such as exercise and weight loss.
The Cobb/Douglas and West End program is helping Felton Keyes, 54, who has fought mental illness and substance abuse. He lives at a Marietta residential program run by the community board, and during the day goes to the organization’s Austell clinic for group therapy and other services. He receives medical care at the same location, and help for his high blood pressure.
He even gets his exercise there. “I stay on the treadmill,’’ he says.
Keyes is impressed with the concept of the program. It treats the “biological, emotional and psychological,’’ he says.
Tod Citron, CEO of the Cobb/Douglas community services boards, says 78 percent of patients there have no insurance. The Affordable Care Act could help sustain this project financially by insuring more of them, he says.
Bearden of Highland Rivers says the collaboratives ‘‘are going to be a model of the future.’’
“Reimbursement is going to shift,’’ he says. Government programs and insurers “will want to pay for these types of services.’
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