Much of the mental health service delivery system architecture was built in the last century when thinking about mental illness was much different from today. Segregation and isolation were supported through well-intentioned yet misguided actions. Large state hospitals and community mental health centers created parallel sys-tems of health care.
If you had a mental illness you went to a different provider than if you had a physical illness. Insurance coverage was vastly different. All of this reinforced the concept that mental illness was something that was unusual, dark, and likely to consume the person forever.
The segregated model of health services employs great care providers who work hard every day to improve the lives of those served. That fact should not be doubted.
The segregated system of care for persons with behavioral health conditions is a long way from ideal. Especially if by ideal you mean it leads to a long and productive life.
In the 1970s, a person with major mental illness had a life expectancy some 10 years less than others. In the 1990s, expected length of life dropped to 15 years lower. In 2006, the National Association of State Mental Health Program Directors reported that number to be 24 years less of life. People with mental health conditions had a life expectancy into their 50s, which is pretty alarming.
At a time when treatment for mental health conditions has rapidly improved, people affected by these conditions died younger. For persons with mental health conditions, death comes the same way as it does for others: heart disease, lung disease and cancer. It just happens sooner; too soon.
Ten years into the 21st century, as we embark on health care reform, this system of segregated care is being challenged.
It is now well-known that people with serious mental illnesses have a three to four times higher chance of having a chronic physical health condition than others. It is also known that if you have a chronic health condition such as heart disease, asthma or diabetes you have a three to four times higher chance of a co-occurring mental health condition.
People with mental health conditions are less likely than others to receive the standard of care for chronic health conditions that others without mental illness receive.
In addition, the person least likely to be encouraged to stop smoking, as well as other devastating health practices, is a person with a major mental illness.
For those individuals with mental health conditions not engaged in care the biggest barrier to obtaining help is the fear of stigma. For many, it is easier to suffer or even end their life than to bear the embarrassment, ridicule, prejudice and fear that they will be cast out or belittled.
People with behavioral health conditions should have a “medical home” and a primary care physician, or PCP, to care for and guide them. As a patient, you or I should be able to go to our doctor and discuss our needs without fear that we will be led away into another “system.” A health partner relationship with a PCP that in-cludes stewardship of the total human health condition — mental and physical — is primary in this emerging model of care.
Acute stabilization, rehabilitation, in-home care, care coordination and continued health management by a PCP are the elements of care that should be included in both physical health and mental health services.
Although high-intensity services such as those provided by a hospital or intense outpatient programs are appropriate, their goal should be to stabilize and return an individual to the care of that person’s selected primary care provider. Such a model will better ensure a holistic approach to health care and preservation of well-ness. Ensuring a respectful, accessible, efficient, effective and client-centered system is perpetuated is the needed outcome.
Improved health, productivity and longevity to live personally selected lives of value is the goal of health care reform. Medical homes are a model of care that improves the deliverability of that goal.
David S. Proffitt is the CEO and president of the Acadia Hospital and a member of the Bangor Area Health Policy Advisory Committee.