Description of the Problem That the Proposed Project Seeks to Solve: People with a serious mental illness, which includes people who have a major mental illness such as schizophrenia or bipolar disorder and also struggle to work and function, die on average 11–30 years earlier than people who do not have a mental illness. The primary reason for this is that it is much more common for people with serious mental illness to have heart diseases that can cause heart attacks and strokes. They develop these heart diseases because they are more likely to be overweight or obese and to smoke, and less likely to exercise and eat healthy. These unhealthy lifestyle behaviors lead to heart disease and also other medical problems like diabetes, high cholesterol, and lung diseases. Some programs have been developed to help teach people to take better care of their health. These include Integrated-Illness Management and Recovery (I-IMR), which was developed by members of the team who will carry out this study, and the Chronic Disease Self-Management Program (CDSMP), which was developed by Kate Lorig and members of her research group at Stanford University. A mental health professional using I-IMR teaches people facts about physical and mental illnesses, how they can affect each other, and how to better manage them together, using handouts and discussion, in two one-on-one meetings followed by 14 group meetings.
Someone who has lived with a chronic medical illness teaches CDSMP, which includes training on how to better manage chronic medical illness, in six group meetings, using handouts. Although the I-IMR and CDSMP programs have been used all over the country and seem to help people, it is not clear which program is most effective at helping people learn to manage their illnesses better so they can lead longer and healthier lives. Therefore, we want to compare I-IMR and CDSMP to learn which one is more effective at improving illness self-management in people with serious mental illness. We have partnered with a very large mental health center, Centerstone (in Kentucky and Tennessee), to carry out this project. Our goal is to invite 600 people who have a serious mental illness and also a chronic medical illness to participate in the project. Interested consumers will sign forms describing the requirements of the study and will meet with a research team member to answer questions about various aspects of their health. Then, they will be randomly assigned, like flipping a coin, to receive I-IMR or CDSMP. They will come back four, eight, and 12 months later to answer the same set of questions so that we can learn which people improve in terms of their health. We will share the results of the study with national organizations, such as the National Council for Behavioral Health and National Alliance on Mental Illness.
Outcomes We Hope to Achieve: We hope that improving illness self-management skills in people with serious mental illnesses who are also living with a chronic health condition and join the study will lower the chance that they will develop serious heart diseases, keep them out of the hospital, and help them improve their quality of life. We also hope that results from this study will help people with serious mental illness, mental health professionals, directors of mental health centers, and insurance companies make better decisions about which illness self-management programs to select.
Brief Background on Why This Project Is Important to Consumers: Consumers have told us that they struggle to manage their physical health and that chronic health conditions make it harder to work toward important and meaningful life goals. They have also told us that they want to take more control of their health care and to better manage their physical and mental health symptoms. As a project team, we talked to many consumers to get input on this project, and consumers repeatedly mentioned the importance of learning about self-management of both physical and mental health. Learning which disease self-management training program is best at improving people’s ability to manage chronic health conditions would provide important information to consumers about which programs to use, and it would provide mental health providers with evidence to help them decide what clinical services to offer.
Explanation of How Consumers and Other Stakeholder Partners Will Help Make the Project Successful: We already created a local consumer advisory board for this project. It includes consumers from Centerstone Kentucky and Centerstone Tennessee. The purpose of the board is to partner with the research team to help with planning, implementing, and evaluating the project in monthly meetings where they will discuss the project. A representative of the group, who is the Director of Peer Support Services at Centerstone Kentucky, will participate in weekly project management meetings and share the recommendations from the board meetings with the research project team. We also created a national advisory panel, made up of peer leaders, consumers, and family members, that will help to offer advice on the project. Finally, we created a key stakeholder advisory group, made up of peer support leaders, representatives from Centerstone, officials from the Departments of Mental Health for Kentucky and Tennessee, and officials from the Medicaid health plan provider in Kentucky. They will meet four times each year for the entire five years of the project to hear how it is going and give the research team their opinions. All of these people will play a crucial role through all stages of this project.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.