Integrating Behavioral Health and Physical Health

1. Integrating Behavioral Health and Physical Health David Conn, Ph.D. Senior Vice President Mental Health Systems, Inc.

2. Mental Health Systems, Inc. (MHS) MHS provides mental health and substance abuse treatment services to individuals and families. • Prevention • Diversion • “Integrated” (Co-Occurring) Behavioral Health (BH) Treatment • We serve Children, Adolescents, and Adults

3. Why Integrated Care • 60% of individuals with serious mental illness (SMI) do not receive ANY physical health care services • Compared to general population, individuals with SMI are 6 times more likely to be diagnosed with a physical health condition • 74% of SMI have chronic physical health condition and account for 1 in 8 ER visits in San Diego

4. Why Integrated Care? • Lifespan of individual with SMI is 25 years shorter than general population • Individuals with SMI and Substance Use Disorder (SUD) have average age of death of 45 • Each person has distinct needs, depending on physical health and Behavioral Health (BH) diagnoses and acuity

5. Integration Models at MHS • Coordinated Care: Communication • Clinic vans at MHS sites (ten years) (mild to moderate BH needs) • Clinic Satellite BH site staffed by MHS (mild/moderate) • Co-Located Care: Proximity • SAMHSA PBHCI Pilot in San Diego (Bi-Lateral Integration) (worked well for low acuity SMI, less well for high acuity SMI) • Mobile Van to build out to full clinic in Fresno (mild to moderate) • Integrated Care Model: Practice Change • MHS/Mountain Health – Putting Primary Care Clinic inside a large mental health clinic (high acuity SMI) • MHS staffing BH within FQHCs in several Counties (mild/moderate)

6. Coordinated Care Model • Works well for high functioning clients (mild BH needs) • Basic Collaboration and communication between BH and Primary Care (PC) services • Memorandum of Agreement between BH & PC • Referrals made each way • Patient/Client information not often shared

7. Co-Located Care Model • Works well for mild/moderate BH needs • BH and PC can be neighbors or in same office • BH and PC screenings used to generate referrals • “Warm” handoffs possible • Allows for greater ease in communication

8. Integrated Care Model • Works well for Complex Clients two or more chronic illnesses or high acuity SMI • Collaborative Care in transformed practice • Shared Vision and Values • Shared setting for service provision • Team-based, patient-centered (whole person) care • Cross-training of BH and PC staff

9. Integrated Care (Cont.) • Bi-directional referral and follow-up • Integrated huddles/case conferences • Evidence-based and practice-tested • Utilizes peer support partners • To assist with organizing • To help with complexity • To interface with family

10. Lessons Learned • SMI consumers are more comfortable accessing services in BH setting, so bring physical health care to them • As acuity abates, referring out is goal – works for a majority of even SMI • PC staff more comfortable seeing SMI patients in BH setting ( more prepared for psychiatric crises) • BH staff lack PC competence, so integration always results in better care

11. Lessons Learned (Cont.) • BH staff and Peers often have trust of SMI patients, making access to physical health care feasible • Peers accompany (high acuity) SMI to see specialists when needed • Sharing of PC/BH information allows better healthcare and better health

12. Questions? David Conn, Ph.D. (858) 395-9085 dconn@mhsinc.org