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Commentary: Missouri leads the way in coordinating mental and physical care

This article first appeared in th St. Louis Beacon, Jan. 6, 2012 - Missouri is quickly becoming a pre-eminent leader in improving the coordination of care for people with serious mental illness and co-occurring, life threatening medical conditions, such as hypertension, diabetes, cardiovascular disease and COPD.

Our state doesn't often find itself in the vanguard of change. We're used to being on the lower half of the leader boards when it comes to the health of our citizens. So, how then did we become a sought-after expert in mental health care delivery?

Most states have seen their mental health system infrastructure crack and crumble under the heavy strain of budget cuts. We in Missouri have also sustained painful cuts, to be sure. But instead of trying to survive by simply scaling back, mental health leaders here have spent the past several years working together across the system to use the resources we do have in the smartest ways possible -- ways that serve our clients and the state's bottom line.

Missouri's efforts to effect life-changing initiatives for people with mental illness and other serious health conditions are driven by a powerful, collaborative environment between the provider community and the Missouri Department of Mental Health.

This partnership took root five years ago when one of Missouri's mental health leaders, Dr. Joe Parks, chief clinical director for the Missouri Department of Mental Health, co-published a benchmark study that shook the mental health community across America. "Morbidity and Mortality in People with Serious Mental Illness" found that those served by our public mental health systems die, on average, 25 years earlier than the general population. More than 80 percent of those premature deaths are due to treatable medical conditions caused by preventable risk factors such as smoking, obesity, substance abuse and inadequate access to medical care.

Numerous other studies showed that people with serious mentally illness and chronic health conditions are more likely than not to receive no medical care whatsoever for those conditions. Both providers and state officials in Missouri came to understand that our system was designed to treat people in emergency situations instead of keeping them from getting acutely ill in the first place. This was not only harmful to those we serve, it also cost taxpayers millions in avoidable costs.

One analysis in our state actually identified a client who showed up at emergency rooms 250 times in a year -- sometimes in multiple emergency rooms in the same day. It would have been cheaper to hire a caseworker assigned 24 hours a day to only him.

Those of us in the mental health community knew we had to do something. We knew we had to act fast (people were dying and the system was crashing financially). And we knew we needed each other to accomplish the kind of systemic change that could turn this problem around. It's like Helen Keller said: "Alone we can do so little; together we can do so much."

There are numerous examples of this collaboration over the past several years, including the establishment of the Behavioral Health Network of Greater St. Louis, dedicated to developing an accessible and coordinated system of mental health care through eastern Missouri. We also worked together to help the state implement a cutting-edge disease management program for those receiving mental health services.

In late 2010, the mental health department, MO Health Net and other stakeholders launched a project targeting 3,700 identified high-cost Medicaid clients with chronic medical conditions who were eligible for but not using mental health services. The state sent these clients letters inviting them to enroll in community mental health so we could coordinate and manage both their medical and psychiatric conditions. The hope for the project is that we'll save money by engaging clients in pro-active care that keeps them healthier.

Missouri is continuing it collaborative efforts to reduce inpatient hospitalization and emergency room visits for persons with serious mental illnesses and serious medical conditions. We are confident these efforts will save millions in taxpayer dollars. But more importantly, such efforts will surely ease untold human suffering.

"Our work together is bearing some great fruit," Dr. Karl Wilson, president and CEO of the Crider Health Center, recently said. "It's like planting an orchard a long time ago and after a lot of nurturing, there are some beautiful sustaining payoffs now."

Federal departments are giving us a green light and expediting Missouri's initiatives because we're a model of what collaboration can accomplish. And other states are asking key people from here to explain how we so quickly effected such change. This is unfamiliar terrain for Missouri. No one has ever asked our opinion before. I think we should be proud to give it.

J. Michael Keller is the executive director of the Independence Center in St. Louis. One of the nation's most successful examples of the Clubhouse Model of Psychosocial Rehabilitation, the center helps adults with serious and persistent mental illness to live and work in the community by focusing on their strengths and abilities, not their illness.