Whole Person Wellness: Integrating Care to Improve Physical Health of Persons With Serious Mental Illness

Historically, treatment for serious mental illness has been separated from the rest of medicine resulting in gaps in medical care, redundant care, and increased costs. To address the healthcare needs of those with serios mental illness, primary care services are now being embedded in and connected to community mental health centers. However, numerous barriers exist including cost, program design, sustainability, and the adaptability of electronic health records. The purpose of this project was to describe and analyze the system changes that occurred in a nationally recognized community mental health center resulting from the implementation of grant-funded initiatives to promote the importance of whole health and wellness by integrating primary and behavioral healthcare into its repertoire of services for persons with serious mental illness. Grant outcomes included increasing the number of persons with serious mental illness who were connected with a primary care provider in the local community and those who have active insurance. These outcomes were successful, as nearly three-quarters of the previously uninsured members became connected with public insurance, and greater than 70% of the members were connected with a community primary care provider. Other deliverables designed to increase the level of integration at the community mental health center encountered barriers, such as staff resistance, electronic health record challenges, philosophical differences, and the need for program re-design and highlighted the lack of coordination between agencies. Recommendations have been made for other community mentla health centers who are pursing efforts to increase the level of integrated care they provide, including relevant lessons learned, effective practical approaches, strategies to overcome common barriers, areas of expansion, and methods for sustainability. This case study suggests that efforts to provide integrated care in a community mental health center may necessitate an organizational culture shift that includes the active, cohesive, and clear support of leadership. In addition, strong theoretical underpinnings are necessary to support the change. Prochaska and DiClemente’s stages of change (1982) and Roger’s Diffusion of Innovations (1962) are examples of theories that can help organizations to successfully adapt to a fully integrated care system.