Bringing health care to the mentally ill

Monterey County wants to revolutionize health care for one of the most difficult to reach groups, the mentally ill.

Its new program will create one-stop health care shopping for people whose main interaction with doctors is through the county’s behavioral health centers.

That means primary care, like regular doctor’s visits, flu shots or diabetes management, will be housed in the same building patients already visit for therapy or drug rehabilitation. And, all patient care will be coordinated on site.

“We think we can provide a wrap-around to help people really succeed,” said Amie Miller, Monterey County Department of Behavioral Health’s project manager for the plan.

The planned three facilities won’t just provide mental and physical health care, Miller said. Patients there will also be able to tap into healthy life skills courses focused on cooking, exercise and more. The plan brings together the county’s public health nurses, clinics and other services to fill an important gap.

“Last year we looked at our severely mentally ill population and 39 percent didn’t see a physician at all,” she said.

On top that, studies show that the lifespan of a mentally ill person in the United States is 25 years shorter than that of the general population.

The deaths aren’t be caused directly by the mental illness either, said Trina Dutta, public health advisor with the Substance Abuse and Mental Health Services Administration.

“These aren’t suicides,” Dutta said. Rather the mentally ill may suffer from related physical ailments like obesity or diabetes. Most often, she said, it is simply more difficult for them to get the health care they need.

Short visits that may not allow a patient to express their concerns or understand instructions can keep the mentally ill away from health clinics. Other barriers include the difficulty of making and keeping appointments while battling mental illness, a lack of insurance or transportation and stigma or fear of it.

Dutta’s agency, part of the US Department of Health and Human Services, is kicking in $400,000 a year for the next four years in grant money to support Monterey County’s program.

In the past, national and Monterey County efforts focused on bringing mental health care services to primary care facilities. So that a family doctor may ask if a patient is feeling depressed and then be able to refer them to a therapist down the hall.

It’s one way to create a health care home for patients, a place where all of their needs are met.

But, that doesn’t serve the severely mentally ill patient as well, said Dr. Wayne Clark, director of Monterey County’s Behavioral Health Department.

“Other populations don’t have an existing chronic illness,” Clark said. “We have special clinics throughout the county that are the place they go to for health care. We need to allow them to have other health issues addressed there, too.”

Integrating all of the services in one location is part of what makes Monterey County’s plan so innovative, Dutta said. Of the 90 grants her agency awarded to bring primary care to mental health care settings, the one to Monterey County is one of the only to include complete health care coordination.

That also means a lot of work.

Project manager Miller is meeting the public health nurses and officials from the county’s health clinics to figure out how they will share patient documents and gauge outcomes.

But she believes that the plan will drop barriers to care while increasing the efficiency of behavioral and physical health care for the 1,800 patients expected to access the centers each year.

The first integrated behavioral health care center in Monterey County is scheduled to open in April. For now, locations are planned on the grounds of the former Fort Ord, at Natividad Medical Center and in King City.

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