Physical and behavioral health care integration in the public sector: One community mental health agency's shaky journey toward FQHC land

With a massive push from all directions toward integrated primary and behavioral health care, Genesee Health System, a community mental health authority in Flint, Michigan, pushed ahead of the crowd to become one of the very first public mental health entities in the country to receive a 330 grant from HRSA, and successfully launch a federally-qualified health center. This was after nearly 10 years of embedding the other local FQHC within its psychiatric clinic. The drivers were clear: A dramatic documented need among the most vulnerable residents in a notoriously vulnerable city (50 percent of all families with young children in Flint live below the Federal Poverty Level), a growing homeless community especially of mothers and children; residents with Serious Mental Illness and co-occurring preventable chronic conditions dying 30-40 years younger than the county's general population; and the need to reduce costs in a capitated system while improving care and outcomes. The goal was simple: Deliver integrated care that improves the length and quality of lives in our community. Unfortunately, despite best intentions, extensive resources and talent, and much excellent planning including a prior year HRSA Planning Grant, the larger system pieces of the health care delivery puzzle are not in place to fully support this goal. Project leaders/administrators will discuss lessons learned and groundbreaking efforts to navigate these unwelcoming systems that have simply not caught up with the needs of populations and the practices already in place to address them.