The Case for Integrated Care: An Organizational Perspective

11231744_991431120876303_1107317938872529402_nAs the full-time grant writer for Aspire Indiana, a comprehensive community mental health center serving central Indiana, I am often privy to new strategies, impending program changes, and and other organizational shifts. Why, you ask? Because I am often tasked with finding money to help fund these programs.

When Aspire’s leadership began batting around the the concept of integrated care, I didn’t give it a lot of thought. Leadership staff at Aspire talk about a lot of things, some of which never gets beyond talk. That’s not a bad thing. Like any good team, Aspires leadership thoroughly vets new programs, discussing pros and cons, and then makes a decision based on a lot of information.

After many discussions, Aspire’s leadership team finally came to the conclusion that integrated care would play an important role in the organization’s future, and so began the ramping-up period.

Finally, on July 1, 2015, Aspire opened its first medical clinic, The Aspire Indiana Health Center located in the Dr. Duane Hoak Building, 215 West 19th Street, Anderson IN 46016. Named after long-time Board member Dr. Duane Hoak, the facility is staffed with a Nurse Practitioner and a nurse. The center is currently accepting new patients.

As a long-time provider of mental health and addiction services in central Indiana, why is Aspire Indiana integrating primary health care into its continuum of care? Why not just stick with what we know? The answer can be found by examining Aspire’s philosophy: “We believe recovery is possible for all the individuals we serve with mental illnesses and substance use disorders.We believe in the resiliency of the adults, children and families we serve who have experienced trauma and other life altering events. We believe traditional mental health services are incomplete without attending to the housing, employment, physical health and wellness, and community integration of the individuals we serve; and the safety, permanency and well-being of the families we serve.”

The average life expectancy in the United States is 77.9 years (Insel). The life expectancy of those with a serious mental illness is 15 to 20 years less (Cassels). Although those with serious mental illness are at a higher risk for suicide, most do not die by suicide. Rather, they die from the same health conditions as the rest of the population: cancer, stroke, heart disease, diabetes, and pulmonary disease. People with mental illness do not properly manage these health conditions. Those with mental illness are also more likely to die from chronic diseases associated with addiction (most often nicotine), obesity (weight gain is a side effect of some antipsychotic medications), and poverty (poor nutrition and poor access to healthcare).

Despite the fact that many Aspire’s consumers have Medicaid, access to care is limited. Many primary care physicians either limit the number of Medicaid patients they will accept, or simply do not accept Medicaid patients. Therefore, consumer access to a health care provider of their choice is very limited.

Co-occurrence of chronic physical health problems in people with serious mental illness is a critical concern. According to a 2004 study, 74% of people with a serious mental illness have a diagnosis of at least one chronic health problem, and half have a diagnosis of two or more chronic health problems (Jones). Examination of current adult consumers who have serious mental illness revealed that 93% have at least one chronic health problem.

Further, there are additional negative symptoms associated with mental illness, including “reduced ability to plan or carry out activities, such as decreased talking and neglect of personal hygiene, or have a loss of interest in everyday activities, social withdrawal or a lack of ability to experience pleasure” (Mayo Clinic) Two of these negative symptoms are particularly problematic for people with mental illness when seeking health care: reduced ability to plan and carry out activities, and loss of motivation. Integration of primary health care provider and behavioral health care services will minimize these barriers.

So, you see, at Aspire, we’re about treating the whole person. We view integration as an opportunity to improve overall patient care, leading to improvement in our patients’ overall quality of life (Samet, et al).

To contact the Aspire Indiana Health, call (765) 393-3891.

Works Cited

Cassels, Caroline. “Much Lower Life Expectancy in the Mentally Ill.” Medscape. 6 Dec. 2011. Web. 26 June 2015.

“Diseases and Conditions: Schizophrenia.” Mayo Clinic. 24 Jan. 2014. Web. 12 Jan. 2015.

Insel, Thomas. “No Health Without Mental Health.” National Institutes of Health. 6 Sept. 2011. Web. 26 June 2015.

Jones, Ph.D., Danson R., Cathaleene Macias, Ph.D., Paul J. Barreira, M.D., William H. Fisher, Ph.D., William  A. Hargreaves,  Ph.D., and Courtenay M. Harding, Ph.D. “Prevalence, Severity,  and Co-occurrence of Chronic Physical Health Problems  of Persons With Serious Mental  Illness.” Psychiatric Services 55.11 (November  2004):  1250-257. Psychiatry Online. Web. 26 June 2015.

Samet, Jeffrey H., MD, MA, MPH, Peter Friedmann, MD, MPH, and Richard Saitz, MD, MPH. “Benefits of Linking Primary Medical Care and Substance Abuse Services.” Archives of Internal Medicine 161.1 (2001): 85-91. The JAMA Network. 8 Jan. 2001. Web. 30 June 2015.

About the Author: Mark Combs, MBA, is a grant writer with Aspire Indiana, and is an aspiring cyclist. You can learn more about Aspire Indiana at https://www.facebook.com/AspireIndiana. You can follow Mr. Combs on Twitter @MarkCombs1968.

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