Mind & body: The case for integrating community mental health and primary medical healthcare services

People with significant psychiatric disorders die, on average, 25 years earlier than the general population and the diseases that they die from tend to be diseases of medical importance (e.g., heart disease, diabetes, etc.). While suicide and injury account for about 30-40% of excess mortality, 60% of premature deaths in persons with schizophrenia, for example, are due to medical conditions such as cardiovascular, pulmonary and infectious diseases. This population also has a higher occurrence of modifiable health risk factors such as smoking and obesity that further exacerbate negative health outcomes. Consequently, an emerging trend in health care delivery and the containment of health care costs involves the provision of integrated behavioral and primary medical health care within environments in which the consumer-patient is already comfortable. A recent survey of patients at a large, urban, mid-Atlantic community behavioral health center illustrates, on a local level, that the population receiving community-based behavioral health services is disproportionately affected by several chronic diseases in addition to their mental disorders. In addition, there is substantial room for improvement in the overall health of these patients and the delivery of their preventive and primary health care services such as could be achieved through the creation of a health home within the community-based behavioral health setting. In spite of the influence of patient behavioral health diagnosis on reported health conditions, over half (55%) of patients surveyed indicate that they either do not talk to their regular medical provider about the behavioral health services they receive or their medical provider was unaware that they receive behavioral health services. Not surprisingly, patients reported benefits of integrating their behavioral and primary medical health care. Health homes, as described in healthcare reform legislation, are intended to address the very health issues that many behavioral health patients (both nationally and in our survey) disproportionately suffer from. The present survey revealed high incidence of self-reported high blood pressure (24%), high cholesterol (41%), and diabetes (27%), coupled with high rates of smoking (56%) and obesity (38%), making a powerful case for an integrated health care solution. The results of this survey highlight the urgent need, in one specific, high-risk, high-cost population, to more effectively address known health disparities, as could be accomplished through one type of health home model.