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New research indicates that people with serious mental illnesses – including schizophrenia, bipolar disorder and major clinical depression – die on average 25 years earlier than the general population. Sixty percent of premature deaths in people with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases.
Unfortunately, people with serious mental illness also suffer from a high prevalence of modifiable risk factors, in particular, obesity and consumption of snuff. Compounding this problem, people with severe mental illness have less access to established monitoring and treatment guidelines for physical health conditions.
Our nation? S health system tends to be fragmented, with greater reliance on the specialists who deal with aspects very specific health / disease continuum.
Fragmentation is most noticeable in the separation between the treatment of mental and physical illnesses. This separation is an artifact of how services have been funded historically, with the preponderance of funding for the treatment of mental illness from States and heads of state psychiatric facilities often – literally and figuratively – away from the mainstream of medical service.
What can do to resolve this tragedy?
There are solutions to this epidemic of premature death and morbidity among people with mental illness. Policy makers can provide policies, resources and leadership to close this gap. We must achieve this goal when we can say that:
– Adequate funding is available to allow all providers of public mental health services to assess the physical health and mental status of clients served in the system public mental health.
– States are learning and following the examples of states like Missouri and Louisiana who are conducting care initiatives primary care home with explicit mechanisms for funding and integrated treatment between mental health and primary care providers for coordination of services.
– State legislatures can create the policy infrastructure through law or regulation to ensure that there is a strong working partnership between health and community mental health organizations in the vendor community. These policies can define functions of these organizations, referral protocols, or allow the placement of the cross and the reimbursement of clinical staff.
Disease: Another promising approach
Regular medical care often fails to meet the needs of patients with chronic diseases, even in managed, integrated delivery systems. The medical literature suggests strategies to improve outcomes in these patients. Effective interventions tend to fall into one of five areas: the use of evidence based on planned care, rehabilitation practice systems and provider roles, improved patient self-management support, greater access to expertise, and greater availability of information clinic. The challenge is to organize these components into an integrated system of care for chronic diseases. One approach to meeting these goals is by creating programs of disease management.
Disease management (DM) is an approach to care coordination for people with chronic or persistent medical conditions for two important reasons: to improve the quality of care and lower costs. The quality is better, because treatment is coordinated across the spectrum of care people with these conditions of use evidence-based practice guidelines and education on disease self-management. States have also been able to reduce costs through this approach.
The Centers for Medicare & Medicaid Services (CMS) issued a letter to state Medicaid directors encouraging the adoption of frameworks Germans. Currently, DM is widely used in the states for asthma, diabetes, hypertension and other persistent medical conditions, and increasingly for members with serious mental illness.
Washington State Example
On June 28, CMS approved a State plan amendment (SPA) for the State Washington used the Benchmark Option Plan to provide regular services to Medicaid state plan further management of the disease (MD), services to adult Medicaid beneficiaries with complex medical needs. The choice of reference state the plan provides States with the opportunity to offer a benefits package alternative to beneficiaries without regard to comparability of services, the requirement for traditional Medicaid.
Medicaid recipients statewide to be identified by a contractor based on claims history, referred by a vendor, or may be self-reference. Eligible beneficiaries are those who are diagnosed with certain conditions medical chronic conditions including diabetes, heart failure, coronary disease, cerebrovascular disease, renal failure, and chronic pain associated with musculoskeletal diseases and other chronic diseases, including comorbid depression and / or anxiety.
In addition to traditional services Medicaid State Plan, the people enrolled in the DM program receive assistance in locating a primary care provider ( "Medical Home") and benefits that are tailored to the specific health needs, including:
– Condition specific education;
– Access to a line nurse call;
– Regularly scheduled telephone management of health care and support, and
– Coordination of care including information to primary care physician.
About the Author:
Linda Rosenberg leads the National Council for Community Behavioral Healthcare in treating children, adults and families with mental illnesses and addiction disorders across the country. She holds faculty appointments at several schools of social work. http://www.thenationalcouncil.org/
Article Source: ArticlesBase.com – An Avoidable Tragedy — the Relationship of Premature Death and Serious Mental Illness
