Susan Grantham and Natalie Truesdell of John Snow, Inc, have been working on a state-wide evaluation of the clinical implementation component of MeHAF's Integration Initiative.
Healthy Amistad, a MEHAF Integration Initiative project, was launched to help people with mental illness improve their physical health through lifestyle changes and helping them to overcome barriers they face in getting medical care.
Studies show that people with severe and persistent mental illness (SPMI) die, on average, 25 years sooner than people of the same age without mental illness, primarily due to chronic disease and other medical co-morbidities that often are undertreated or untreated. The problem can often be traced to lifestyles, impact of medications, and increased risks of chronic health conditions.
These factors are compounded by a fragmented health care system in which mental and physical illnesses are treated entirely separately, and a health system that focuses on illness rather than wellness. Additionally, bias and stigma related to mental illness and lack of medical provider familiarity and experience caring for persons with SPMI can negatively affect care and the patient-provider relationship.
Members of Amistad, a peer support and recovery center near Portland, decided to try to address the disparities in health and life expectancy for those with mental illness. To start, Healthy Amistad focused on helping their members with mental illness improve their overall health through increased focus on healthy diet and physical activity. They hired a chef to develop a Healthy Amistad nutrition program, who introduced healthier lunch choices and a salad bar to the onsite cafeteria choices. New social activities with a physical component, such as walking, hiking and bowling, were also introduced.
Healthy Amistad brought in a Peer Patient Navigator (PPN), someone with personal experience with mental illness, to help members in their interactions with the medical care system.
The PPN helped Amistad clients by making and accompanying clients to medical appointments, encouraging follow-through on treatment plans and encouraging patients to seek care before a medical condition became a crisis. At a primary care providers' office, the PPN might provide information about the client's medical history or medications, help the client ask questions, keep notes on what was discussed and take the client to the lab for tests.
As a result of Healthy Amistad, Amistad reported that, "The mindset of health became integrated into the fabric of the organization." Many who needed to lose weight did, and people were eating more salads and fewer of the less healthy choices at lunch.
In addition, members were able to get to their medical appointments and reported feeling more comfortable there. The number of "no-shows" and emergency room visits dropped. Primary care practice nurses came to see the PPN as a valued team member.
The case study offers guidance for other organizations seeking to incorporate Healthy Amistad ideas, such as recommended Peer Patient Navigator skills, potential challenges and advice on how to get started, and how to sustain and fund a PPN program. The full report [UPLOAD REPORT] provides more details on the Healthy Amistad program and some of the results of the program for the Healthy Amistad members.
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