Integrated care is happening for Maricopa County’s mentally ill
Published: July 26, 2013 at 9:27 am
People with mental health and substance-abuse challenges are finding and maintaining recovery with the support of innovative and effective clinical and peer-driven practices.
The behavioral health system in central Arizona is thriving and integrated care — providing for both the physical and mental health of individuals — is at the center of our continued efforts. It has been for two years.
Conceived in 2009 and launched in 2011, through the leadership and vision of Gov. Jan Brewer, Integrated Health Homes (IHH) now operate in 10 of the 20 mental health clinics in Maricopa County. The physical and behavioral health needs of individuals challenged with severe mental illness are being effectively managed through a person-centered, population-based, data driven and evidenced-based approach.
Magellan Health Services has care management teams that help with coordinating transitional care when these individuals are hospitalized for medical reasons. The time period immediately after a medical hospital discharge is a critical time in the life of a member with serious mental illness (SMI). Current disease and case management has not been very effective for SMI members. Magellan’s transition team by virtue of the behavioral health expertise has made significant inroads in making this transition smooth.
The IHH model includes more than just co-location of behavioral and physical health care services. It’s about whole-person care and includes training of peer support team members in Stanford’s Chronic Disease Self-Management Program, health and wellness training and mentoring, and providing support for hospitalized individuals.
The service experience is focused on self-directed recovery — assisting each person to identify strengths and needs in terms of skills, resources and support. We recognize that people should be the pilot of their own recovery and wellness, and we are alongside to engage, collaborate and support. Member input into recovery goals, wellness plans, services and interventions is paramount. In short, recovery — mentally and physically — is owned, self-directed and defined by the member.
The most important aspect of what we’re doing is the improved quality of life that members are experiencing.
Statistics show that those with mental illness die 25-to-30 years earlier than their peers who do not face the same challenges. As a doctor who has practiced medicine in this system for more than 10 years, I’ve long felt this approach is essential to improving and saving lives. I’m extremely proud that Magellan and our providers saw this need years ago, and with the governor’s leadership began proactively addressing it.
I have seen many people positively impacted by the IHH. For example:
- One man, who had been misdiagnosed with anxiety, learned at his IHH clinic that he had a congenital heart defect — he had been taking anti-anxiety medicine for years for a condition he did not even have.
- A woman who was frequently being readmitted to the hospital with breathing problems was helped at her IHH clinic when it was discovered that symptoms of her schizoaffective disorder were preventing her from using her prescribed inhaler properly.
- A woman who had been afraid to see her physical doctor because of stigma was escorted by her behavioral health provider to the office across the hall of a physical health provider, at the IHH clinic, when a wound on her face would not heal. She was treated for MRSA — a very serious infection.
- Another young woman lost 70 pounds when her IHH nurse practitioner discovered she was pre-diabetic and provided self-care guidance.
These are just a few of the numerous stories that have emerged since the IHHs began operating. Today, more than 92 percent of all members diagnosed with severe mental illness — more than 13,000 people — have completed a health risk assessment with a nurse, which helps identify physical health conditions, patterns of seeking (or not seeking) health care, and lifestyle habits that affect overall health and well-being. Then they are assigned an IHH, which allows them to receive whole health integrated services in a coordinated approach.
Clearly, the promise of integrated health services is here in Maricopa County today and providing extraordinary outcomes.
From my vantage point, I see a system providing an innovative and integrated care solution, and significantly improving the quality of life for some of our state’s most vulnerable citizens. I invite those on the periphery of Arizona’s system of care to join me on the front lines and see firsthand the meaningful outcomes in integrated services that I see being realized every day.
~Dr. Shareh Ghani, board-certified physician, psychiatric medicine, Arizona since 2003, Magellan Health Services of Arizona.