Wednesday, November 12, 2008

An Innovative Solution for Those with Mental Illness (Part I)

Catholic Health World, a publication of the Catholic Health Association of the United States, recently published an article on CHRISTUS’ practice of using Community Health Workers to help patients access behavioral health services in Texas.

I have said before that I believe the health care industry has failed miserably in the delivery of behavioral health.

As recently as ten years ago, many inpatient behavioral health facilities were cleared and closed, driven especially by the rapid decline of reimbursement by both governmental and private insurers. (In addition, it was believed that the rapid development of medications to treat psychiatric illnesses would clear our inpatient mental health facilities, which has not been the case.) Consequently, our streets became filled with people unable to work or care for themselves, which has added to the growing number of uninsured and underserved in our country.

Therefore, CHRISTUS is working on innovative and cost-effective solutions to aid patients in difficult situations when the resources available to them are few.

The Catholic Health World article summarizes Texas’ problem well, as it is the state “with the highest number of uninsured residents and one of the smallest per-capita public investments in mental health services in the nation.”

Therefore, CHRISTUS is working to strengthen the safety net for these seriously ill patients—many of whom are homeless--by helping them access a number of needed services in addition to mental health assistance, such as housing and job search help.

We do this in South Texas by utilizing Community Health Workers (CHWs), who we have historically used to help clients with high-ED utilization to access health resources at the appropriate level of care, find medical homes and help to prevent and manage chronic illnesses.

These original CHWs were part of an innovative pilot program started in the CHRISTUS Spohn region, and generally do not have a background in health care. However, we provide them with training and then assign them to 9 or 10 chronically ill, uninsured people.

The CHWs really become navigators for these people, to get them as expeditiously through the health care system as possible, but also provide them with resources that permit them to monitor their health care status at home, hoping that they will require less costly health care services as they continue life’s journey.

Our initial data from studying the patients cared for by these general CHWs show that their ED visits have been reduced drastically, the medications they have taken could be eliminated or reduced also, and their activities of daily living are enhanced.

Now, CHWs are being used to assist those with mental illness as well, which I will examine in more depth in my next blog post.

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