50 Years Ago, a Start to the Mental Health Conversation; 50 Years Later, Still Further to Go

Fifty years ago on Oct. 31, 1963, President John F. Kennedy signed the Community Mental Health Act into law, ensuring that individuals with mental illness receive the support services and care they need in a community setting, as opposed to institutional settings more common at the time. In that day and age, in such a public way, President Kennedy's signature signified a large step forward in reducing the stigma and mystery around common mental health and behavioral conditions with which so many people had silently dealt.

Decades later, the Mental Health Parity Act -- reinforced by the Affordable Care Act -- helped ensure that individuals with mental illness receive the same access to care as their peers with physical ailments, such as arthritis or a heart condition.

The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that approximately 10.4 million Americans have serious mental illness (SMI), a grouping of diagnoses such as schizophrenia, bipolar disease, major depression and post-traumatic stress disorder. Many people with SMI also deal with chronic medical conditions in addition to the challenges of living with mental illness. Our own data shows a very high prevalence of risk factors in the SMI population, such as smoking and non-prescription drug use, as well as chronic illnesses such diabetes, asthma, chronic obstructive lung disease (COPD) and heart disease. People with SMI may also lack physical activity and proper nutrition. Social factors can be a barrier to treatment, with a third of the people in the Medicaid population living alone and another third maintaining few social connections.

Angela is a 35-year-old woman with diabetes, hypertension, and schizophrenia who lives alone and does not have many social contacts. She has a good relationship with her therapist at the local Community Mental Health Center (CMHC) but feels that primary care physicians are often uncomfortable with her. In the past, she has used emergency room treatment to control her diabetes.

In the last year, Angela has been part of an innovative concept called an integrated health home at her CMHC. While the word "home" may invoke a physical dwelling, an integrated health home is a holistic approach to care -- often virtual -- that addresses the need for support, coordination, and access to care to ensure the member truly has the chance to live a healthier life. Behavioral and physical health care are coordinated, and often located in the same facility, with additional supports available to those who need them.

At her first appointment, Angela's blood pressure and blood sugar were high. The clinician noted that some of the drugs for schizophrenia could be affecting her blood sugar and contacted her therapist. After discussing the situation, they suggested some changes to Angela's medications. Since Angela was socially isolated, her providers also arranged for a peer support specialist to visit her to help implement her treatment plan and subsequent follow-up.

Within a month, Angela's blood pressure was under control and her blood sugar level had markedly improved. She now schedules appointments with both her physical and mental health clinicians on the same day and regularly keeps both appointments. She has had no recent emergency room visits or hospitalizations.

While the stigma around mental illness has decreased, people with SMI still face barriers to care that are both obvious and subtle. SMI causes people to have problems organizing their thoughts and their lives. They may act differently from others, and may be treated differently by providers who do not understand their illness. They may be blamed for not following up on their treatment plans, but do not have the infrastructure to support adherence to their providers' recommendations.

The integrated health home concept is one that illustrates how relatively simple and straightforward adjustments to the care delivery model can be very successful in improving outcomes and lowering the cost of treatment.

None of these changes are overly complex or very costly, but they do require that we look past the individual conditions and treatments and implement the integrated care and community services and supports that were envisioned in the Community Mental Health Act 50 years ago.

About Magellan Health Services: Headquartered in Avon, Conn., Magellan Health Services Inc. is a leading specialty health care management organization with expertise in managing behavioral health, radiology, and pharmacy benefits programs, as well as integrated health care programs for special populations. Magellan delivers innovative solutions to improve quality outcomes and optimize the cost of care for those we serve. As of September 30, 2013, Magellan's customers include health plans, employers and government agencies, serving approximately 33.9 million members in our behavioral health business, 17.5 million members in our radiology benefits management segment, and approximately 9.2 million members in our medical pharmacy management product. In addition, the pharmacy solutions segment served 39 health plans and employers, 25 states and the District of Columbia, and several pharmaceutical manufacturers. For more information, visit www.MagellanHealth.com.