Jeff O’Neil, MEd, PCC Director of Community Services

1. Addressing Severe Mental Illnessand Physical Health Issues: A Ground-level Perspective From A Community Behavioral Health OrganizationGreater Cincinnati Behavioral Health Services (GCB) Jeff O’Neil, MEd, PCC Director of Community Services

2. GCB At A Glance Our Mission: "To assist persons with mental illness and related barriers to lead productive and fulfilling lives." • A Provider of Comprehensive Services To Adults and Youth with Severe and Persistent Mental Illnesses • 40 year service history • Supported by local MH levy funding, Mental Health Board, grants and insurance reimbursement (Medicaid, Medicare) • 4500 served annually • 300 Staff

3. Achieving Our Mission By Providing Comprehensive Mental Health Services • Psychiatry • Nursing • Care Management • Assertive Community Treatment • Counseling • Vocational • Residential / Housing • Day Treatment • Specialized Programs with: Courts, Jails, Hospitals Programs, Homeless, Youth, Deaf

4. Typical Presenting Profiles • Severe MH Diagnoses Schizophrenia, Psychosis, Bipolar Disorder, Major Depression, Dual Diagnoses, etc. • Further Complicated by Physical Health Issues… Substance Abuse Smoking Obesity-related Diabetes Hypertension Metabolic syndromes Respiratory problems etc.

5. Other Complex Factors Poverty Social Problems Isolation Motivation Issues Histories of Trauma Behavioral & Lifestyle Cultural

6. Access To Care Issues • Many have not been accessing routine or any healthcare • May be unaware of their physical health (due to MH symptoms, lack of experience or education) • Typically using expensive services (ERs, Inpatient, LTC) for emergency care and when unmanaged health issues become problematic • Insurance coverage issues or no coverage • Healthcare Providers not interested in serving the population

7. …Barriers, Barriers, Barriers!

8. An Emerging National Recognition That Community Behavioral Health Organizations Are: • Positioned Well To Address These Complex Health Issues and Barriers with the SMI • Through Integration of Behavioral and Physical Healthcare • By Taking on The Responsibility for the Coordination of all the Healthcare needs • Care Management: Impacting high costs, quality of the care and health outcomes

9. …Why Behavioral Health? • An already “captive audience” • Trusting client relationships…can transfer to other providers • Advantage of providing “hands-on” Care Management and wrap-around supports for access to care, coordination of care and follow-up • Assertive Outreach and Engagement oriented -75% of GCB’s services are in clients’ community settings -Staff visit clients in their homes, under bridges, the streets, river banks, etc. • A “specialized” expertise and understanding to serve the population

10. Many BH’s Expanding Our Scope • To assist our clients in caring for their mind and body • By assisting to coordinate both their mental and physical health needs • Commitment to reverse the catastrophic course of persons with SMI dying 15-25 years earlier than the population!

11. With National, State and Local SupportSupporting BH to do things not historically funded for… • Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) • Department of Health and Human Services Health Resources and Services Administration (HRSA) • National Council for Community Behavioral Healthcare / SAMHSA / HRSA partnered to create “Center for Integrated Health Solutions” • States Adopting Medicaid Health Homes for SPMI (Ohio and several others) • Local MH Boards • Local Foundations (eg: The Health Foundation of Greater Cincinnati)

12. New and Innovative Approaches at GCB-Partnership with A Federally Qualified Health Center (FQHC) - • Co-located the FQHC (The HealthCare Connection) in the BH clinic • Improving access to Primary Care • 600 GCB clients receiving on-site Primary Care • Beginning to share health information

13. New and Innovative Approaches at GCB-Pharmacy Services- • Co-located a full-service Pharmacy in the BH clinic • Improving access to medications • Providing BH and PH medications to over 1200 clients!

14. New and Innovative Approaches at GCBHolistic Health Project – Cincinnati • Funded by SAMHSA’s “Grants For Primary and Behavioral Healthcare Integration”, 2 of 4 years • Implemented: Nurse Care Managers Peer Wellness Coaches Wellness Services Primary Care Physician Consultant • Connect clients to Primary Care • Collecting and Reporting: height, weight, BMI, blood pressure, fasting glucose, HgbA1c, cholesterols • Over 700 clients enrolled • Beginning to evaluate…

15. New and Innovative Approaches at GCB-Wellness Services- • Nutrition Group • Cooking Group • Walking Group • Losing Weight Group • Low Resistance Exercise • Chronic Disease Management (eg: diabetes) • Health Education (Women’s Health / Men’s Health) • Smoking Cessation • Health Fairs / Screening • Nurses using health education resources and tools - food models, health promotion models (smoking dummy, diseased lung, food portion plates, etc.

16. New and Innovative Approaches at GCB-Addressing Obesity Issues with SMI Clients- • Awarded a Mini-Pilot • 5K Funded by The Health Foundation of Greater Cincinnati • Provided for supplies and educational materials • Needed to purchase a scale that measures to 1000 lbs. • Used data to target 20 clients with the highest BMI • Clients Worked with Nurses and Peer Wellness Coaches • Provided individual and group support focused on nutrition, exercise, healthy food choices • Tracked BMI for a 10 month period • 68% reduced their BMI by a minimum of 2 pts • Learning: Focused interventions for targeted health issues can produce positive results

17. Integration of Care For Persons with SMIIs Transformational Work! • Behavioral Health Field • States’ BH delivery systems • BH Organizations: GCB on our way to becoming a full Health Home 2013 to help coordinate all healthcare needs with the SMI • Clients’ Recovery!

18. THANK YOU!