Addressing Severe Mental Illness and Physical Health Issues: A Ground-level Perspective From A Community Behavioral Health Organization Greater Cincinnati Behavioral Health Services (GCB) Jeff O’Neil, MEd, PCC Director of Community Services Jeff O’Neil, MEd, PCC Director of Community Services

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

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

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.

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

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

…Barriers, Barriers, Barriers!

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

…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

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 years earlier than the population!

With National, State and Local Support Supporting 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)

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

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!

New and Innovative Approaches at GCB Holistic 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…

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.

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

Integration of Care For Persons with SMI Is 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!

THANK YOU!