Mental Health Services Paying Dividends
As America continues plotting the path of healthcare reform, other states can borrow a road map from Colorado. Dozens of important initiatives have been underway across the state for years and they are proving that healthcare integration can save lives and scarce resources.
State budget cuts over the past decade forced Colorado’s community mental health system to find ways to serve more people with less state funding. Meanwhile, with Medicaid enrollment at an all-time high in Colorado, the system continues serving record numbers of people – about 100,000 individuals per year. The financial imperative in the face of rising demand has fueled ongoing healthcare innovation and transformation across the entire state.
One of the keys to this transformation is integrating behavioral healthcare with physical care in numerous shared settings, including:
- 14 Private Practice Primary Care Offices
- 33 Federally Qualified Health Center Treatment Sites
- 19 School-Based Health Centers
- 7 Hospitals/Medical Centers
- 9 Community Non-profit Healthcare Organizations (non FQHC)
- 4 Local Health or Social Services Departments
“These new partnerships and programs demonstrate the importance of treating the whole person. In some cases, our teams treat the entire family,” said George DelGrosso, executive director of the Colorado Behavioral Healthcare Council (CBHC). “This simple method of increasing access and coordinating care is helping reach more people who have an undiagnosed and untreated mental illness before problems escalate across multiple systems.”
To demonstrate the community mental health system’s commitment to integration across Colorado, CBHC is mapping all of the locations where its members are currently providing integrated services. This mapping project demonstrates the expanse of collaborative efforts underway and is a tool to help assess needs and share successes of diverse collaborative arrangements with different populations across the state.
“People with co-morbid conditions drive up the cost of the healthcare system when one condition goes undiagnosed or untreated,” said Linda Rosenberg, president & CEO of the National Council for Community Behavioral Healthcare. “Most of us have witnessed or experienced the connection between mental and physical health in our own lives. The connection cannot be ignored if we hope to provide effective treatment.”
As Rosenberg explained, people with severe and persistent mental illness often have other conditions, such as diabetes, heart disease, or alcoholism that go undetected, which complicates care and recovery. In contrast, many people with cancer, heart disease and other physical conditions, have untreated depression or anxiety, which can seriously complicate those conditions. To overcome these challenges, multi-disciplinary teams are emerging to serve people in easily accessible locations—where people live, work, and normally go for healthcare services. With greater integration of services, by infusing mental health, addictions treatments, and physical health together in one location, the needs of the whole person can be addressed concurrently to ensure better outcomes and improved overall patient satisfaction. This approach also utilizes precious healthcare dollars more effectively and reduces costs over the long-term.
The Mental Health Center of Denver (MHCD), for example, recently added to its integrated system with a new $500,000 grant that will help the center further integrate physical and behavioral health care. Its PRICARe program co-locates a family practice physician from the University of Colorado Department of Family Medicine at an MHCD adult clinic. Meanwhile, the center’s PRICARe Plus program will integrate a nurse practitioner from Denver Health within its recovery-focused treatment programs. The project adds nurses who help manage consumers with chronic medical conditions such as diabetes or heart disease. The nurses’ are coordinating care and promoting healthier lifestyles. To accommodate this new capacity, MHCD is adding three new medical exam rooms to create access to primary care and establish a medical home within the community mental health center where consumers are already engaged and feel most comfortable.
People who are developmentally disabled who have a mental illness also are benefiting from the trend toward integrated healthcare. This population often perceives many barriers to receiving services for both their developmental disability and their mental illness. The logistical challenge of visiting numerous locations is a big barrier to anyone, but an important healthcare program in Boulder and Broomfield counties now provides integrated healthcare in one location to all 140 developmentally disabled individuals in the service area who have a mental health disorder (100 percent of the target population). It’s the first program of its kind in Colorado and one of few in the nation.
As DelGrosso explained, people with serious mental illnesses such as schizophrenia and bipolar disorder die an average of 25 years sooner than other Americans. Three out of every five people with serious mental illnesses die from preventable, co-occurring chronic diseases such as asthma, diabetes, cancer, heart disease and cardiopulmonary conditions. Integrated care will help reverse this problem, he said.
Healthcare integration is a multi-directional street. Just as behavioral health services have been brought into primary care settings, there are many successful models where primary care is integrated into behavioral healthcare sites. Furthermore, healthcare services have been successfully integrated into shared points of delivery, such as School-Based Health Centers. Members of the Colorado Behavioral Healthcare Council have tailored their collaborative efforts to meet the unique needs of each community, pulling from the diverse pool of community resources available to help assure success. To help reduce barriers to treatment and improve health outcomes, community mental health centers are linking with various community resources to integrate mental health, substance use, and physical health treatment services.
“To realize the potential of integrated care, we need to overcome some of the turf issues and fragmentation caused by split funding streams,” DelGrosso said. “The comprehensive and integrated management of chronic disease is the way of the future.”