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Establishing an Integrated Health Care Clinic in a Community Mental Health Center: Lessons Learned

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Abstract

Integrating primary care with behavioral health services at community mental health centers is one response to the disparity in mortality and morbidity experienced by adults with serious mental illnesses and co-occurring substance use disorders. Many integration models have been developed in response to the Primary and Behavioral Health Care Integration (PBHCI) initiative of the Substance Abuse and Mental Health Services Administration (SAMHSA). One model is a primary care clinic co-located within the mental health center. The Connecticut Mental Health Center (CMHC) Wellness Center is one such co-located clinic developed as a partnership between CMHC and a Federally Qualified Health Center (FQHC). In this article, we describe the process of developing this on-site clinic along with lessons learned during implementation. We review different aspects of building and maintaining such a clinic and outline lessons learned from both successes and challenges. We briefly describe the demographics and health characteristics of the patient population served in this clinic. We make recommendations for providers and agencies that are considering or are already developing a model for integrating care. Finally, we briefly review status of our clinic after completion of grant funding.

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References

  1. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015;72(4):334–41.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing chronic disease. 2006;3(2):A42.

    PubMed  PubMed Central  Google Scholar 

  3. Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Medical care. 2011;49(6):599–604.

    Article  PubMed  Google Scholar 

  4. Nasrallah HA, Meyer JM, Goff DC, McEvoy JP, Davis SM, Stroup TS, et al. Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophrenia research. 2006;86(1–3):15–22.

    Article  PubMed  Google Scholar 

  5. SAMHSA-HRSA Center for Integrated Health Solutions. Standard framework for levels of integrated healthcare [cited 2015 Jan 11]. Available from: http://www.integration.samhsa.gov/resource/standard-framework-for-levels-of-integrated-healthcare.

  6. Druss BG, von Esenwein SA. Improving general medical care for persons with mental and addictive disorders: systematic review. Gen Hosp Psychiatry. 2006;28(2):145–53.

    Article  PubMed  Google Scholar 

  7. Gilmer TP, Henwood BF, Goode M, Sarkin AJ, Innes-Gomberg D. Implementation of Integrated Health Homes and Health Outcomes for Persons With Serious Mental Illness in Los Angeles County. Psychiatr Serv. 2016;67(10):1062–7.

    Article  PubMed  Google Scholar 

  8. Druss BG, von Esenwein SA, Compton MT, Rask KJ, Zhao L, Parker RM. A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study. The American journal of psychiatry. 2010;167(2):151–9.

    Article  PubMed  Google Scholar 

  9. Scharf DM, Schmidt Hackbarth N, Eberhart NK, Horvitz-Lennon M, Beckman R, Han B, et al. General Medical Outcomes From the Primary and Behavioral Health Care Integration Grant Program. Psychiatr Serv. 2016;67(11):1226–32.

    Article  PubMed  Google Scholar 

  10. Krupski A, West, II, Scharf DM, Hopfenbeck J, Andrus G, Joesch JM, et al. Integrating Primary Care Into Community Mental Health Centers: Impact on Utilization and Costs of Health Care. Psychiatr Serv. 2016;67(11):1233–9.

    Article  PubMed  Google Scholar 

  11. Druss BG, von Esenwein SA, Glick GE, Deubler E, Lally C, Ward MC, et al. Randomized Trial of an Integrated Behavioral Health Home: The Health Outcomes Management and Evaluation (HOME) Study. The American journal of psychiatry. 2017;174(3):246–55.

    Article  PubMed  Google Scholar 

  12. Bellamy CD, E HF, Costa M, O'Connell-Bonarrigo M, Tana Le T, Guy K, et al. Barriers and Facilitators of Healthcare for People with Mental Illness: Why Integrated Patient Centered Healthcare Is Necessary. Issues Ment Health Nurs. 2016;37(6):421–8.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Larry Davidson, Ph.D., for his support of the evaluation team throughout the project and critical review of this manuscript

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Correspondence to Aniyizhai Annamalai.

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Funding

The project was funded by Substance Abuse and Mental health Services Administration (SAMHSA) H97SM061007

This work was supported by the Connecticut Department of Mental Health and Addiction Services (DMHAS). But the opinions expressed in this article do not necessarily reflect the views of DMHAS.

Conflict of Interest

The authors declare that they have no competing interests.

Ethical Approval

All procedures performed in this project were in accordance with the ethical standards of the local Institutional Review Board and with the 1964 Helsinki declaration and its later amendments.

Informed Consent

Informed consent was obtained from all participants in this project.

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Annamalai, A., Staeheli, M., Cole, R.A. et al. Establishing an Integrated Health Care Clinic in a Community Mental Health Center: Lessons Learned. Psychiatr Q 89, 169–181 (2018). https://doi.org/10.1007/s11126-017-9523-x

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  • DOI: https://doi.org/10.1007/s11126-017-9523-x

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