February 23, 2016; CNN (Kaiser Health News)
Serious mental illness (SMI), including schizophrenia, bipolar disorder, and major depression, affects more than 9.5 million adults, almost four percent of adults living in the United States. A 2006 report from the National Association of State Mental Health Programs revealed adults suffering from SMI die an average of twenty-five years earlier than those without these conditions, and that the rate is rising. Grants funded through the federal Substance Abuse and Mental Health Services Administration (SAMHSA) indicate locating physicians and other physical medical partners in mental health clinics improves physical health in this needy population.
Although Tracy Young has to take two buses to San Fernando Mental Health Center, she never misses an appointment. The fifty-year-old describes these appointments as key to controlling her depression and schizophrenia.
Unfortunately, like many people suffering from mental illness, Young did not always receive regular medical care. The lack of essential care leads to a higher percentage of people with severe mental illness dying prematurely, often from treatable chronic diseases such as hypertension, diabetes, and obesity. It also leads to an increase in the cost of care and gaps in the care received.
Frequently, the barriers low income individuals suffering from mental illness face are due to transportation and lack of integrated care between the mental and physical health care systems. Increasing cooperation and communication between providers is a goal of the Affordable Care Act.
In the past, leaders focused on adding mental health services to physical health offices. Recent grants are focused on offering physical health services in mental health clinics, as is the case at San Fernando Mental Health Center. Joint clinics are in development in many states, including California, New York, Washington, and Florida. Many are funded by grants administered under the Primary and Behavioral Health Care Integration (PBHCI) program of SAMHSA. Since 2009, the department has awarded $150 million in grants for this purpose.
Clinics funded under the program received up to $500,000 annually to integrate physical and mental services. In 2014, The RAND Corporation evaluated fifty-six of these programs around the country. Their study revealed patients receiving primary care at their mental health clinic increased their control of their diabetes and hypertension. Results were not as positive for patients who smoked or suffered from obesity.
The clinics also reported early enrollment success measured by over half of patients using integrated services in the first year they were offered. But care specialists found it difficult to target those most likely to benefit from integrated care.
Although many of these clinics successfully developed models of co-locating behavioral and primary care services, they struggled to develop a joint culture and long-term funding.