HEALTH ACCESS AND INTEGRATION
FOR ADULTS WITH SERIOUS AND
PERSISTENT MENTAL ILLNESS
Judith B. Boardman, RN, MSNCS, Ph.D.
Individuals with serious and persistent mental illness are among the disenfranchised in todays United States society. This group includes many who are homeless, unemployed, or working for minimum wage. They are often underserved or unserved while they encounter a multitude of access barriers to quality healthcare. An historical review of representative literature reveals that although known for over a quarter of a century, evidence-based practices regarding treatment of co-morbid behavioral and primary health needs of seriously mentally ill individuals have not been standardized.
The HES Health Access and Integration Program began as a performance improvement project within our healthcare network. A 2002 randomized retrospective review of service utilization revealed that consumers with serious and persistent mental illness used the hospital Emergency Departments six times more often than the general patient population. We further found that patients with serious mental illness access routine ambulatory care half as often as their non-mentally ill counterparts. These findings are consistent with the related literature.
In 2003, we conducted a randomized, controlled field study in which consumers with serious and persistent mental illness received routine primary healthcare through a nurse practitioner based in the behavioral healthcare setting. The results were remarkably successful in reducing Emergency Department visits and increasing access to routine medical care for this vulnerable population. Due to the generous support of the Blue Cross Blue Shield Foundation of Massachusetts and Northeast Health System, the program has continued service delivery in Salem with plans to expand to HES services sites in Haverhill and Lawrence, MA.
The data presented supports current literature and makes the economic and societal case for an integrated model of behavioral and primary healthcare for seriously mentally ill, which is embedded in the behavioral healthcare setting. At the present time, Boston University plans to conduct federally funded research related to this program in all three sites.
The Health Access and Integration Program Questions and Answers
Q1. Why would a client want to go to the Health Access Program?
A1. The client can receive both medical and behavioral healthcare in one place. One-stop-shopping helps to make healthcare more convenient.
Q2. Who does a client see at The Health Access Program?
A2. The client is examined and treated by a nurse practitioner. The nurse practitioner will spend the needed time with the client to get a sense of what the medical needs might be.
Q3. What kinds of problems does the nurse practitioner take care of?
A3. Weight management, diabetes, skin problems, muscle aches, heart problems, lung problems and many other conditions.
Q4. Does this program replace the primary care physician (PCP)?
A4. No, the client may also see a PCP or choose to just see the nurse practitioner.
Q5. Do the nurse practitioner and the PCP work together?
A5. Yes, with the client's permission, the nurse practitioner will contact the PCP and coordinate the treatment.
Q6. Who can be seen by the HES nurse practitioner?
A6. Any HES client can be seen at the Health Access Program.
Q7. How does an HES client get referred to the Health Access Program?
A7. An HES client can be referred to The Health Access Program by a therapist, case manager or PCP. The client can ask at the front desk at an HES Outpatient site or call (888) 682-2224 and ask for an appointment with the nurse practitioner.
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