Shawnee Mental Health Center Spotlight
Center brings primary care to mental health clients, earns federal funds
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.
Prescription Drop Box Map
Results show shift in perception from substance abuse being seen as moral failure to a chronic illness.
The Kentucky Health Issues Poll (KHIP) found that 7 in 10 Kentucky adults believe that addiction is a disease (70%). Attitudes towards addiction as a disease were the same both among respondents who have a family member or friend who has experienced problems with substance abuse, and among those who did not indicate such firsthand experience with addiction.
Kentucky adults continue to cite heroin use as causing problems for friends, family
The most recent Kentucky Health Issues Poll (KHIP) and Ohio Health Issues Poll (OHIP) has found that more than 2 in 10 Ohio adults (23%) report knowing someone who has trouble as a result of using heroin, while just under 2 in 10 Kentucky adults (16%) report knowing someone affected by heroin use.
8 in 10 Ohio adults say it’s easy to buy healthy foods in their neighborhood
A majority of Ohio adults (81%) agree that it is easy to buy healthy foods in their neighborhood. However, responses vary by income. Nearly 9 in 10 Ohio adults in households earning more than 200% of the Federal Poverty Guidelines (87%) agree. That compares with fewer than 8 in 10 adults in households earning 200% FPG or less.
Half of Ohio young adults have used an e-cigarette
Nearly 3 in 10 Ohio adults (28 percent) reported having ever used an e-cigarette, according to the most recent Ohio Health Issues Poll (OHIP), sponsored by Interact for Health. This is higher than in 2016 (19 percent) and about the same as in 2015 (24 percent).
Half of homes with children have guns
The most recent Ohio Health Issues Poll (OHIP) found more than 4 in 10 (42%) of Ohio adults report keeping at least one firearm in or around their home. This number has increased from 2013, when 36% reported keeping a firearm.
Number drops to slightly less than half in Northern Kentucky
A majority (56%) of Kentucky adults say childhood obesity is a serious problem in the state, according to the most recent Kentucky Health Issues Poll.
Nearly all support having a nurse in each school building.
The most recent Kentucky Health Issues Poll (KHIP) found that more than 8 in 10 Kentucky adults (84%) strongly or somewhat favor schools taking a more active role in helping families get health care services for children. Healthy students are able to achieve more academic success than those facing challenges to their health.
More Kentucky adults have favorable opinion about ACA
The most recent Kentucky Health Issues Poll (KHIP) found that more Kentucky adults have a favorable opinion of the Patient Protection and Affordable Care Act (ACA) (44%) than a negative opinion (33%). The percent of adults with a favorable opinion has been increasing since the poll first started tracking the ACA in 2010, when it became law. In 2010, 26% had a favorable opinion of the ACA.
One in 4 Kentucky adults concerned about losing their health insurance.
Rate of employer-sponsored health insurance declines; more Northern Kentucky adults lack insurance than in rest of state. The most recent Kentucky Health Issues Poll (KHIP) found one in four (24%) of insured Kentucky adults ages 18 to 64 are concerned about losing health coverage within the next year.
Kentucky adults overwhelmingly favor tobacco-free schools.
The most recent Kentucky Health Issues Poll (KHIP) found that nearly 9 in 10 adults (87%) favor schools adopting tobacco-free campus policies in their communities. Support for tobacco-free school policies has been consistently strong -- favored by 85% of Kentucky adults in 2015 and 84% in 2013.
Most Kentucky adults favor raising minimum age to buy tobacco to 21.
The most recent Kentucky Health Issues Poll (KHIP) found that nearly 6 in 10 Kentucky adults (58 percent) favor raising the minimum legal age to buy tobacco products from 18 to 21. This support has held steady since 2015, the first time KHIP asked this question. Interact for Health and the Foundation for a Healthy Kentucky sponsored the poll.
Nearly half of young adults in Kentucky have tried an e-cigarette
The most recent Kentucky Health Issues Poll (KHIP) found that nearly 3 in 10 Kentucky adults reported ever using e-cigarettes. The rate is higher than national statistics, where just over 2 in 10 adults reported ever using e-cigarettes. The highest reported use was among young adults in Kentucky, where nearly half said they had ever used an e-cigarette.
Most Kentucky adults support a comprehensive statewide smoke-free law
The 2017 Kentucky Health Issues Poll (KHIP) found that 71 percent of Kentucky adults support a comprehensive statewide smoke-free law. This remains the highest level of support since the poll began tracking this topic.
Half of Ohio adults say they favor needle exchange programs
Half of Ohio adults (50 percent) said they favor and about 4 in 10 Ohio adults (42 percent) said they oppose needle exchange programs, according to the most recent Ohio Health Issues Poll (OHIP).
6 in 10 Ohio adults favor raising minimum age to buy tobacco to 21
Six in 10 Ohio adults (58 percent) favor raising the minimum age to buy tobacco from 18 to 21 according to the 2017 Ohio Health Issues Poll (OHIP). This is an increase from 2016. A majority of Democrats (67 percent) and Republicans (60 percent) favored increasing the purchase age to 21. OHIP also asked if Ohio adults support a tax increase of 65 cents per pack of cigarettes; half of Ohio adults (53 percent) were in support.
2 in 10 allow smoking in homes.
The 2017 Community Health Status Survey (CHSS), funded by Interact for Health, has found that 23 percent of adults in the Greater Cincinnati and Northern Kentucky area are current smokers. Although the rate has been steadily declining, our region is still higher than the nation, where 18 percent of adults were smokers in 2015.
Greater Cincinnati Health Watch
Greater Cincinnati Health Watch is a free biweekly e-mail newsletter published by Interact for Health. Each issue includes health news stories from Ohio, Indiana, Kentucky, and the nation, with emphasis on topics related to Interact for Health's focus areas of substance use disorders, severe mental illness, school-aged children's healthcare, and community primary care.