In bringing on physician Sacari Thomas-Mohamed to head up the medical side of the clinic, FSI is at the leading edge of a trend toward what’s called health-care integration — the idea that medical professionals of all stripes should work together to treat the range of ailments a patient might be experiencing at one time. FSI is one of 93 clinics across the country that’s been given part of $174 million in grant money by the Substance Abuse and Mental Health Services Administration over the next four years to help them accomplish just that.
Although SAMHSA is still evaluating its grantees’ results — the official report is due at the end of this year — the agency said the clinics have together seen improvements of 10 to 46 percent across a variety of their patients’ health indicators, such as body mass index and blood pressure.
People with serious mental illnesses, such as schizophrenia, die 25 years younger than the general population on average, according to a 2006 study by the National Association of State Mental Health Program Directors. Factors such as transportation issues, fear of stigma and lack of insurance keep them from making and keeping regular doctors’ appointments.
Three relatively young FSI clients died within two years, which inspired the clinic to apply for one of the SAMHSA grants in 2010 to help them start integrating.
“People under the age of 55 were dying of diabetes, heart attack and stroke,” FSI director Arleen Rogan said. “We wanted to see how to make a difference in that.”
FSI’s program is an extreme manifestation of integrated care — most clinics opt for simply asking psychiatrists and doctors to compare notes or to share health records. But increasingly, clinics and hospitals are streamlining access to care for patients who have co-occurring mental and physical health disorders.
“With the advent of health-care reform, services are going to need to be less redundant, more efficient, more patient-centered, less provider-centric,” said Mark McGovern, a psychiatry professor at Dartmouth University who has studied mental health integration.
Integration predates the Affordable Care Act, but the health-care bill did call for the creation of models that allow patients to be managed by interdisciplinary teams of doctors. Payments will also shift from services to outcomes, so doctors will have more incentives to work together to cure a patient for good.