Effectively Addressing “Total Health” for the Chronically Mentally Ill Community Client

The majority of the early deaths among the SMI population are due to the same chronic illnesses identified and typically treated much earlier in the general public. Their lack of access to preventive and ongoing care results in disability and disproportionally costly care commonly accessed at a late stage of the illness and in an emergency setting. In the public mental health system there is little collaboration between behavioral health specialists and physical health providers. To begin to address their SMI client's physical health needs, CAHSD implemented a smoke free campus policy; a low barrier smoking cessation program; a physical health screening policy, tool and referral process; medical case management; a primary care integration model within the CAHSD clinics; and financial assistance earmarked for indigent clients referred to a medical home. Findings from this initiative identified a high medical appointment keep rate at 78%, a high percentage of co-morbidity at 41% with 4+ medical conditions, and a need for specialty, not primary care, given the level of morbidity and chronic disease progression.The CAHSD was awarded the SAMHSA, Primary and Behavioral Health Care Integration grant to refine and expand the current local model and reach more than 7,500 public mental health clinic clients. The new program will be focused on prevention and wellness programming, such as smoking cessation, physical exercise and nutrition education; and Registered Nurse care management establishing relationships and referrals to medical homes and ensuring sample and data collection of required physical health parameters.