Shawnee Mental Health Center Spotlight

Center brings primary care to mental health clients, earns federal funds

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ACCORDING TO THE National Institute of Mental Health, 5.8 percent of adults in the United States have a severe mental illness such as schizophrenia, bipolar disorder or major depression. Studies have found that people with severe mental illnesses have higher rates of chronic diseases such as diabetes and high blood pressure. In addition, the Centers for Disease Control and Prevention has found that people with mental illnesses are more likely to smoke. A 2006 study by the National Association of State Mental Health Prgoram Directors Medical Directors Council found that people with severe mental illnesses die approximately 25 years earlier than other Americans.

Research has also found that when people with severe mental illnesses have physical health problems, they often seek treatment in an emergency room. This is an expensive and inefficient way to solve preventable health problems.

A problem in rural Ohio

This was the situation faced by Shawnee Mental Health Center in 2006. Shawnee is the only provider offering a full array of mental health services in Ohio’s rural Adams, Lawrence and Scioto counties. Through a planning grant from the Health Foundation, it had found that 32 percent of its clients had a chronic, diagnosed physical health problem and 55 percent smoked often. In addition, 25 percent had no primary care physician and more than 50 percent used the emergency room for routine care.

One way to improve the overall health of people with severe mental illnesses is to bring physical health care services into existing mental healthcare programs. This is the solution that Shawnee pursued.

“We believed that it was our responsibility as mental health providers to take action and start looking at the whole person and their whole health and not just a person’s mental health" said Cynthia Holstein, director of standards and certification at Shawnee. “We saw that it was time to reconnect the body and mind and address both as part of care."

Improvements in health

With its three-year $297,100 implementation grant from the Health Foundation, Shawnee hired a nurse practitioner to provide routine medical care at three clinics, one in each county. These services included physical health assessments, wellness check-ups, management of diabetes and hypertension, and the treatment of sinus infections, nausea, ear infections and other ailments. A wellness curriculum and basic assessment form were developed and the nurse practitioner was educated in smoking cessation.

Because of the new services, Shawnee’s clients have seen improvements in their physical health. Among patients with diabetes, 56 percent had the recommended blood sugar level of 7 or lower on the HbA1c test, 65 percent of patients with high blood pressure had a minimum (diastolic) pressure of 85, and 34 percent of clients in a wellness group quit smoking. And with physical healthcare available at the clinics, 55 percent of clients said they used the emergency room less.

Steady growth in participation

Shawnee executives traveled to the clinics in each county to explain the importance of the primary care program. The enrollment of new clients for primary care services became a “friendly competition" among the clinics, Holstein said.

“We actively promoted the program in staff meetings on a regular basis and posted weekly updates in staff areas regarding how many new referrals each county received the previous week," she said.

Thanks to these efforts, the number of primary care clients increased from 86 in the first year of the grant to 496 in the third year.

SAMHSA takes notice; primary care services expanded

Shawnee’s success at integrating primary and behavioral healthcare was recognized by the federal government. In 2009 it was one of 13 programs nationwide to be awarded a $2 million four-year grant by the Substance Abuse and Mental Health Services Administration (SAMHSA).

“Physical health problems among people with serious mental illnesses impact their quality of life and contribute to disproportionate premature deaths," acting SAMSHA administrator Eric Broderick said. “These community health programs will help address disparities in treatment by providing more people in need with better access to screening and care management."

With the federal grant money Shawnee has hired one full-time and one part-time nurse practitioner, and three licensed practical nurses. Three peer wellness coaches – former mental health clients who share their recovery stories – have also been hired. Two exam rooms have been added and more medical equipment such as EKG machines has been purchased. Vaccines for flu and hepatitis B are now offered. Holstein said that because of the Health Foundation’s planning and implementation grants, Shawnee was able to gather data and develop expertise that helped it win the SAMHSA grant.

“We had experience with implementing integrated care on a small scale and were able to show that we had many of the components in place," she said.

“People with severe mental illness that were not getting care are now getting care and their health is improving, they are engaging in physical fitness and healthy nutrition.

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