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 (SUD sites ten years) (mild to moderate MH needs now)
Clinic Satellite BH site staffed by MHS (mild/moderate)
SUD clients receive MAT at FQHC
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. David Conn, Ph.D. (858) 395-9085 dconn@mhsinc.org
Questions?
David Conn, Ph.D.
(858)