Project Summary
Adults with serious mental illnesses (SMI) die an average of 25 years earlier than other Americans due, in part, to untreated or poorly treated medical conditions such as obesity, hypertension, and diabetes. Several strategies for improving the physical health of this population have been developed that show promise, including screening for risk factors, co-location of primary care in mental health settings, coordination of physical and mental health care, and using peers to help people access the healthcare system and take better care of themselves. What we do not yet know is who will choose to use these practices when they are implemented in real-world settings, in what combinations, with what short-term effects, and with what health outcomes. We also do not know whether additional strategies may be needed for persons for whom these strategies are not effective.
This proposal seeks to answer these questions by comparing the use and effectiveness of different evidence-based practices that are being implemented as part of a newly established Wellness Center—an integrated primary and behavioral healthcare center—at our local community mental health center. In addition to offering primary care on-site, the Wellness Center will facilitate screening of up to 360 poor, urban adults with serious mental illnesses for risk factors and medical conditions, and offer care coordination and access to peer health navigators, combining the four strategies above.
Phase 1 will involve evaluating the use of and outcomes generated by the different components of this center, while Phase 2 will involve developing and piloting an augmentation strategy to improve the health of clients who have yet to derive any benefits from the Wellness Center. Using both qualitative and quantitative methods, our specific aims are to: understand more about who chooses to use which Wellness Center services and in what combinations, with what short-term effects, and leading to what health outcomes; identify barriers to and facilitators of access, service use, and improvements in person-centered outcomes and elicit suggestions for changes and additional interventions to improve the quality and effectiveness of the Wellness Center; and collaborate with persons in recovery to develop and pilot a new peer-led, community-based intervention to enhance access and choice, and improve person-centered health outcomes, among 40 clients who show no improvement in 12- month outcomes from using the Wellness Center.
Findings from this comparative effectiveness study will be used to inform policy makers and practitioners about the practices that work best for different subgroups of persons with SMI on the health outcomes that matter to them most. This model can then be disseminated to mental health centers around the country to improve the physical health and extend the longevity of this under-served population.
Bellamy CD, H Flanagan E, Costa M, O'Connell-Bonarrigo M, Tana Le T, Guy K, Antunes K, Steiner JL. Barriers and Facilitators of Healthcare for People with Mental Illness: Why Integrated Patient Centered HealthCare is Necessary. Issues Ment Health Nurs. 2016 Apr 22:1-8. [Epub ahead of print] PubMed PMID: 27104370. (Abstract only available)
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