One Ohio woman with a serious mental illness was visiting the emergency room a dozen times a month—all unnecessarily. "If she was lonely, she would go to the ER," said Cynthia Holstein, M.A., who directs the health home project at Shawnee Mental Health Center, Inc., in Portsmouth, OH.
Before the state launched its health home program for adults and children with serious mental illnesses last year, staff at the center had no idea that the woman had developed such an expensive habit. "Our staff has always just dealt with mental health issues and not dived into other issues," said Ms. Holstein. "If we didn't ask about it, they didn't tell us."
Thanks to the health home program, however, mental health team leaders and other staff now know everything that's going on with an individual's health. The Center receives data showing clients' diagnoses and use of health-care services. "Having that information is going to help us understand patients or clients better and help us work with them to develop a plan of care to help them reach their goals," said Ms. Holstein.
The center also has the staff it needs to achieve those goals. As one of SAMHSA's Primary and Behavioral Health Care Integration grantees, it has primary care clinicians who can help clients tackle anything from colds to out-of-control diabetes. Care coordinators develop overall plans, while care navigators help put those plans into practice, taking people to the doctor, making sure they have the medication they need, and even helping them get nutritious food and adequate housing. Wellness coaches help patients with such tasks as getting to the gym to combat weight gain caused by their psychiatric medications.
With such coordinated care, the woman who liked to visit the ER has reduced this habit. The staff worked with her to develop better coping strategies, such as contacting the center or writing problems down. As a result, the woman hasn't been to the ER once in a two-week period. Although the team will have to remain vigilant to keep that reduction going, said Ms. Holstein, "That's fantastic!"
That approach is already paying off, not just in terms of improved health but in decreased costs, said Dr. Parks. "The early results show that the program saves more than it costs," he said, explaining that participants now cost about $160 less per month than before.
For more information, visit Shawnee Mental Health Center's health home website .
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