Friday, June 26, 2009

Newark Medical Center to integrate physical, mental health care

From The Star-Ledger in N.J.:

NEWARK, N.J. -- Sameerah Rhodes hasn't visited a doctor's office since 2005. Luis Ortiz (pictured) can't even remember the last time he had a check up.

Both lack medical insurance and the means to travel to a doctor's office. Even if they did, both said they would be reluctant to go: The trip would cost them a full day of therapy at University Behavioral HealthCare in Newark, where both said they receive daily treatment for depression.

"I don't want to miss a day, because it helps a lot," Ortiz said.

But starting this week, neither Ortiz nor Rhodes will have to leave the center in order to get the medical attention they need. Instead, they can head to the new Yaffa Rose Integrated Care Center, located on the ground floor of the University of Medicine and Dentistry of New Jersey's facility.

Funded by an anonymous donor, the center is among the first programs in the country to provide on-site medical care for patients receiving treatment for mental illness, and represents a national push to integrate mental and physical health care.

"Providing this kind of care in a single setting, rather than having a person who has a disabling condition go from place to place to receive care -- that's actually the key," said Phil Libutz, said associate director of the National Alliance on Mental Illness in New Jersey. "It's one of the first programs of its kind. ... certainly a welcome occurrence in New Jersey."

The need to address physical health problems among people with serious mental illness is dire, according to the National Council for Community Behavioral Health Care.

The life expectancy for people with serious mental illness is 25 years lower than it is for the general population -- a fact attributable not to suicide or accident rates, but to preventable illness including cardiovascular disease, diabetes and asthma, the council reports.

Many people with serious mental illness are unable to work and lack medical insurance, said Dr. Winthrop Dillaway, a faculty member at the University of Medicine and Dentistry, who will be the Yaffa Rose Integrated Care Center's full time primary care physician.

Some medications required to treat mental health issues can make patients more prone to physical disorders, such as diabetes or hypertension, Dillaway said.

And many people with serious mental illness are unable to manage their physical health needs, struggling to make and keep doctor's appointments, or keep track of their medical records and prescriptions.

"They're so overwhelmed with their mental illness that it's really hard for them to take care of themselves," Dillaway said.

The Yaffa Rose Integrated Care Center will address many of these issues simply by virtue of its location -- patients won't have to make costly, time-consuming trips to see doctors off-site.

They will also be less likely to turn to emergency rooms for medical treatment, said Avis Scott, the clinician administrator of the Adult Extended Day Program at UBHC, noting some of her patients visit the emergency room up between eight and 12 times a year.

Caroline Ndumele, a nurse in the Adult Extended Day Program at UBHC in Newark, said the new program will also keep her and other staff members from spending long hours hounding other doctors' offices for medical records, or accompanying patients to appointments.

"When it comes to mental health, the best thing we can do is spend time with our clients -- not on the phone, or doing paper work," she said.

Kevin Martone, deputy commissioner of the state Department of Human Services, said while other New Jersey mental health care providers are incorporating physical health care into their services, he is not aware of any other program that has achieved integration to this extent.

One reason, he said, is that primary care doctors are often reluctant to participate, noting many of the patients are under- or uninsured and they are not fully reimbursed for their services.

But thanks to the $200,000 annual contribution from the anonymous donor, the UBHC center in Newark -- a converted laboratory on the ground floor now complete with a fish tank and shelves full of potted plants -- will be open five days a week, said Mark Johnson, chair of the Department of Family Medicine at UMDNJ and one of the programs architects.

The same donor has also committed $200,000 a year to establish a separate program integrating physical and mental health care in partnership with University Behavioral HealthCare programs in Middlesex County, said Shula Minsky, director of quality improvement for UBHC.

Through that program, which started last September, patients at UBHC locations in Piscataway, Monmouth Junction and Edison can get medical treatment from a physician's assistant at the Yaffa Rose Project, a clinic housed within Catholic Charities' St. John's Clinic in New Brunswick. UBHC provides the patients with referrals, with transportation to the clinic when needed, Minsky said.

Although the program is still new, Minsky said her staff is already observing a decrease in emergency room trips among their clients.

At the Newark program, she said, where "there is no transportation involved. ... It makes it that much easier to get to the doctor."

Although these programs were only possible because of the donation, Martone said both programs -- particularly the one in Newark -- represent a broad push among health care reform advocates to develop dedicated funding sources for coordinated care.

"What you're seeing right now in health care reform on the national level really gets at the importance of coordinated care, really pushing systems to do that and to make sure that reimbursements reflects the need," he said. "Health care reform legislation will very likely push reimbursement packages so that these type of settings become viable."

Of the venture in Newark, he added, "We would be very interested in seeing the type of outcomes that come out of this model."