Meeting the Health Care Needs of Adults with Severe Mental Illness

Adults with severe mental disorders suffer from higher-than-average rates of chronic conditions, such as hypertension and diabetes. Yet this population has less access to treatment and receives poorer quality of care than adults without mental illness. A team of analysts from the University of Pittsburgh and RAND outlined a framework and identified specific steps to improve general health care for this group. The team concluded that a key contributor to this problem is disconnection between the mental health care sector, which provides most of the care for the severely mentally ill, and the general health care sector. To address this problem, the analysts made a number of recommendations aimed at improving the level of clinical integration between these sectors, outlined in the following steps:

• Reorganize mental health service delivery to facilitate clinical integration. This step would involve mental health care providers assuming greater responsibility for their patients' general health, including screening for prevalent general health problems and helping patients develop self-management skills for chronic illness.
• Promote greater communication and collaboration among providers across the mental health and general health sectors, through the adoption of integrated clinical information systems and more balanced privacy rules.
• Prepare the health care workforce to meet all the health care needs of this population. This step involves both sets of providers acquiring skills and competencies, as well as making attitudinal changes, in a broad effort that spans several institutions.
• Develop financing policies and practices that reward integrated care, such as building into reimbursement policies provisions for cross-care and expectations for coordination and information-sharing.
• Strengthen accreditation processes so that accredited health plans share uniform coordination-related requirements. This step could involve asking the Agency for Healthcare Research and Quality to develop measures to assess care for people with severe mental illness.
• Develop federally sponsored research and demonstrations focused on coordination. Research needs to evaluate the feasibility and effectiveness of quality improvement interventions and of evidence-based practices for people with severe mental illness that might be well suited to improving this population's general health outcomes.