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How Peer Specialists Can Help Consumers Reach Wellness and Health Goals . James Schuster, MD, MBA, Community Care Behavioral Health Organization, Pittsburgh, PA Margaret Park, Recovery Specialist Allegheny County Department of Human Services September 15, 2011. Our goals for today . 2.

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How Peer Specialists Can Help Consumers Reach Wellness and Health Goals

James Schuster, MD, MBA, Community Care Behavioral Health Organization, Pittsburgh, PAMargaret Park, Recovery SpecialistAllegheny County Department of Human ServicesSeptember 15, 2011


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Our goals for today Health Goals

2

Look at the research on life expectancy for people living with serious mental illness

Learn what the statistics mean for real life and real people

Understand how peers can help consumers improve their wellness and physical health


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Pennslyvania HealthChoices Health Goals

  • Medical Assistance (Medicaid) Managed Care Program

  • Department of Public Welfare; Office of Mental Health and Substance Abuse Services Oversight

  • Statewide Behavioral Health Carve-Out

    • 1915b Federal waiver

    • County government is the recipient of funds

    • County government contracting models vary


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About Community Care Health Goals

Behavioral Health Managed Care Company

Founded in 1996

Federally tax exempt non-profit 501(c)3

Sole member corporation (UPMC) – provider owned

Licensed as a Risk-Assuming PPO

Major focus: publicly funded behavioral healthcare system

Identified BHO for Hudson Valley Region


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About Community Care Health Goals

  • Medicaid/HealthChoices membership: 700,000

  • Commercial/Medicare membership: 430,000

  • Statewide HealthChoices presence

    • 36 of 67 Pennsylvania counties

  • 8 offices across Pennsylvania

  • More than 500 employees

  • Approximately 110,000 people served

  • Statewide network of more than 2,500 providers


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Susquehanna Health Goals

Warren

Warren

McKean

McKean

Tioga

Tioga

Bradford

Bradford

Potter

Potter

Wayne

Wayne

Wyoming

Forest

Forest

Cameron

Cameron

Lackawanna

Elk

Elk

Sullivan

Sullivan

Pike

Jefferson

Clarion

Luzerne

Columbia

Columbia

Monroe

Montour

Montour

Clearfield

Clearfield

Centre

Union

Union

Centre

Carbon

Northum-

berland

Northum-

berland

Snyder

Snyder

Mifflin

Schuylkill

Juniata

Allegheny

Allegheny

Berks

Berks

Huntingdon

Huntingdon

Chester

Chester

York

York

Adams

Adams

Community Care Counties

Erie

Susquehanna

Crawford

Wyoming

Venango

Lackawanna

Pike

Lycoming

Mercer

Clinton

Clarion

Luzerne

Jefferson

Monroe

Lawrence

Butler

Carbon

Armstrong

Northampton

Beaver

Schuylkill

Indiana

Mifflin

Lehigh

Juniata

Blair

Cambria

Lebanon

Berks

Perry

Bucks

Dauphin

Westmoreland

Washington

Cumberland

Montgomery

Lancaster

Chester

Bedford

Somerset

Franklin

Fayette

Fulton

York

Adams

Greene

Philadelphia

Delaware

Community Care Office

Community Care Contract


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What Do We Know about Physical Health in Adults with Serious Mental Illnesses?

People with serious behavioral illness die earlier than the general population.

People without SMI who have risk factors common to SMI (i.e. smoking, poverty, homelessness, obesity) also die much earlier than the general population

Our behavioral and physical health systems have failed to systematically address and support prevention and wellness across all populations, especially those which suffer from socioeconomic disadvantages

National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA.


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Impact of Various Factors Mental Illnesses?

Suicide and injury account for about 30-40% of excess mortality in people with SMI

Sixty percent of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary and infectious diseases.

About 3 out of 5 people with SMI who die prematurely die from mostly preventable diseases.


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Smoking Mental Illnesses?

Higher prevalence (56-88% for patients with schizophrenia) of cigarette smoking (up to 44% of all cigarettes sold in US are purchased by people with SMI)

More toxic exposure for patients who smoke (more cigarettes, larger portion consumed)

Smoking is associated with increased insulin resistance

Similar prevalence in bipolar disorder

Smoking cessation may be the modifiable risk factor that is likely to have the greatest impact on decreasing mortality

George TP et al. Nicotine and Tobacco Use in Schizophrenia. In: Meyer JM, Nasrallah HA, eds. Medical Illness and Schizophrenia. American Psychiatric Publishing, Inc. 2003; Ziedonis D. Williams JM, Smelson D. Am J Med Sci. 2003 (Oct); 326(4): 223-330.

National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA.


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Obesity Mental Illnesses?

  • Obesity among persons with serious mental disorders is greater than among the general population

  • Increased incidence of Metabolic Syndrome in SMI population

  • Obesity in individuals with mental disorders attributed to a number of factors:

    • a sedentary lifestyle

    • poor nutritional choices

    • lack of access to healthy food (which is also associated with poverty)

    • the effects of both the mental disorder itself and the medications used to treat it

    • lack of access to adequate preventative medical care

      National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA.

      Citromea, L., Vreeland, B., Obesity and Mental Illness. Thakore J, Leonard BE (eds): Metabolic Effects of Psychotropic Drugs. Basel, Karger, 2009, vol 26, pp 25-46.


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    Coronary Mental Illnesses? Heart Disease

    The leading cause of death worldwide

    Following cardiac events, individuals with mental illness experience a 14% lower rate of invasive coronary interventions (47% in the case of schizophrenia) and an 11% increased mortality rate

    Despite continued improvements of care, inequalities in the quality of care of those with mental health diagnoses have been documented including the receipt of preventive care

    Mitchell, A.J., Lawrence, D., (2011). Revascularization and mortality rates following acute coronary syndromes in people with severe mental illness: comparative meta-analysis. The British Journal of Psychiatry, 198, 434-441.

    Hennekens C.H., Hennekens, A. R., Hollar, D., Casey, D. E., Schizophrenia and increased risks of cardiovascular disease. Am Heart J, 2005; 150: 1115-21.


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    Suicide Mental Illnesses?

    Suicide is the 11th leading cause of death in the U.S. (CDC)

    An estimated 2-15% of individuals diagnosed with major depression die by suicide

    An estimated 3-20% of individuals diagnosed with bipolar disorder die by suicide

    An estimated 6-15% of individuals diagnosed with schizophrenia die by suicide

    Suicide is the leading cause of premature death in those diagnosed with schizophrenia

    http://mentalhealth.samhsa.gov/suicideprevention/suicidefacts.asp


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    Impact Mental Illnesses?of Medications

    Problems with psychiatric medications can include:

    Overweight and obesity

    Insulin resistance

    Diabetes and hyperglycemia

    Dyslipidemia

    National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA.


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    Inadequate Access to Physical Health Care Mental Illnesses?

    Lack of capacity in some health care systems

    Stigma and discrimination

    Poor quality and poor provision of services in some areas

    Lack of adequate health care coverage (in some areas)

    Monitoring and treatment guidelines are underutilized with the SMI population (as they are in most populations)

    National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA.


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    Vulnerabilities Mental Illnesses?

    People with SMI are vulnerable due to higher rates of:

    Homelessness

    Victimization or trauma

    Unemployment

    Poverty

    Incarceration

    Social Isolation

    National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA.


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    Why do we have shorter life spans? Mental Illnesses?

    Some of the lost years of life are because of mental health symptoms like suicide & risk-taking behavior (30% to 40%)

    Most of the premature deaths of people with mental illnesses are due to heart problems, strokes & complications from diabetes. (60% to 70%)


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    60% - 70%: Preventable & Treatable Illnesses Mental Illnesses?

    Obesity (and antipsychotics & antidepressants can increase that problem)

    Diabetes (atypical antipsychotics are linked)

    High cholesterol (antidepressants)

    Smoking (double the general population)

    Low rates of physical activity & exercise

    Substance use and misuse

    Lack of good medical care (‘flu’ shots, regular tests…)


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    All of these problems are “synergistic Mental Illnesses?”

    Smoking increases your risk of breathing problems, allergies, colds and the ‘flu’, heart disease & cancer.

    Being overweight increases your risk of breathing problems, diabetes, heart disease (high cholesterol & stroke) and cancer.

    Lack of regular exercise increases your risk of breathing problems, heart disease, diabetes, & cancer.


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    Synergistic effects cont’d Mental Illnesses?

    Diabetes creates complications for all your internal organs including your heart and lungs, kidney, liver and makes it harder to heal from infections.

    Psychotropic Medications increase your risks of heart disease, obesity and diabetes.

    The combination of these factors increases your risk many times



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    What is the GOOD news? Mental Illnesses?

    Adding years to life is possible! There are proven ways of doing just that

    Developing stress hardiness-ways that work

    Choices and strengths work in wellness just as they do in recovery


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    Who, What, Where, When & How? Mental Illnesses?

    Who knows more about recovery and resiliency than we do?

    Who knows more about peer support, coaching and sponsorship than we do?

    We can lead the way.


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    Leadership characteristics Mental Illnesses?

    Leaders change things

    Leaders act with humility

    Leaders are not victimhood. Leaders do no blame others, they work with them

    Leaders define reality through data. Helping people measure success

    Leaders develop and test changes. What works?

    6. Leaders are courageous

    7. Leaders persuade by being honest, patient and persistent

    8. Leaders are empowered by the people who believe in them. They are believable.

    9. Leaders are not defeated by negativity

    10. Leaders think outside the box


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    Elements to consider Mental Illnesses?

    Wellness Dimensions

    Stress Hardiness (bouncing back in life)

    WRAP and Peer Support Principles

    Leadership Characteristics


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    Person-Centered: Choices Matter Mental Illnesses?

    Used with permission from Peggy Swarbrick


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    Teaching Stress Hardiness Mental Illnesses?

    Challenge-threat v opportunity, self-determination, efficacy

    Control—internal loci v. external loci, knowing which is which

    Commitment- capacity and willingness to make a commitment

    Reduces risk of developing stress related health problems by50%


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    Some Principles of WRAP Mental Illnesses?

    People develop hope by making their own plans

    Each encounter focuses on the person’s self-determination, empowerment and choice.

    Mutual respect and unconditional acceptance are maintained

    ALL diversity is accepted and support (incl. mental diversity)

    All goals and plans are supported without judgment

    There are no pre-established limits to recovery.

    The focus is always on what people do well

    Informed choice is a primary ethical determinant. Questions are treated respectably as valuable


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    What Can We Act On? Mental Illnesses?

    Many consumers have serious wellness and physical health challenges

    If we don’t do anything about them, many people will die at relatively young ages

    There are lots of activities and strategies that can help consumers get healthier and ADD years to their lives

    Peers can provide leadership in these efforts and help consumers to reach these goals


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    Resources Mental Illnesses?

    Reinerstsen, J.L. (1998) Physicians as Leaders in the Improvement of Health Care Systems. American College of Physicians, 128(10), 833-838.

    Susan Kobasa, http://stresscourse.tripod.com/id106.html

    Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29,(4) 311- 314.


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