Addressing Severe Mental Illness
and Physical Health Issues:
A Ground-level Perspective From A
Community Behavioral Health Organization
Greater Cincinnati
Behavioral Health Services (GCB)
Jeff O’Neil, MEd, PCC
Director of Community Services
GCB At A Glance
Our Mission:
"To assist persons with mental illness and related barriers to
lead productive and fulfilling lives."
• A Provider of Comprehensive Services To Adults and Youth
with Severe and Persistent Mental Illnesses
• 40 year service history
• Supported by local MH levy funding, Mental Health Board,
grants and insurance reimbursement (Medicaid, Medicare)
• 4500 served annually
• 300 Staff
Achieving Our Mission
By Providing Comprehensive Mental Health Services
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Psychiatry
Nursing
Care Management
Assertive Community Treatment
Counseling
Vocational
Residential / Housing
Day Treatment
Specialized Programs with: Courts, Jails, Hospitals Programs,
Homeless, Youth, Deaf
Typical Presenting Profiles
• Severe MH Diagnoses
Schizophrenia, Psychosis, Bipolar Disorder, Major
Depression, Dual Diagnoses, etc.
• Further Complicated by Physical Health Issues…
Substance Abuse
Smoking
Obesity-related
Diabetes
Hypertension
Metabolic syndromes
Respiratory problems
etc.
Other Complex Factors
Poverty
Social Problems
Isolation
Motivation Issues
Histories of Trauma
Behavioral & Lifestyle
Cultural
Access To Care Issues
• Many have not been accessing routine or any healthcare
• May be unaware of their physical health (due to MH
symptoms, lack of experience or education)
• Typically using expensive services (ERs, Inpatient, LTC) for
emergency care and when unmanaged health issues become
problematic
• Insurance coverage issues or no coverage
• Healthcare Providers not interested in serving the population
…Barriers, Barriers, Barriers!
An Emerging National Recognition That Community
Behavioral Health Organizations Are:
• Positioned Well To Address These Complex Health Issues
and Barriers with the SMI
• Through Integration of Behavioral and Physical
Healthcare
• By Taking on The Responsibility for the Coordination of all
the Healthcare needs
• Care Management: Impacting high costs, quality of the
care and health outcomes
…Why Behavioral Health?
• An already “captive audience”
• Trusting client relationships…can transfer to other
providers
• Advantage of providing “hands-on” Care Management
and wrap-around supports for access to care,
coordination of care and follow-up
• Assertive Outreach and Engagement oriented
-75% of GCB’s services are in clients’ community
settings
-Staff visit clients in their homes, under bridges, the
streets, river banks, etc.
• A “specialized” expertise and understanding to serve the
population
Many BH’s Expanding Our Scope
• To assist our clients in caring for their mind and body
• By assisting to coordinate both their mental and
physical health needs
• Commitment to reverse the catastrophic course of
persons with SMI dying 15-25 years earlier than the
population!
With National, State and Local Support
Supporting BH to do things not historically funded for…
• Department of Health and Human Services Substance Abuse and
Mental Health Services Administration (SAMHSA)
• Department of Health and Human Services Health Resources and
Services Administration (HRSA)
• National Council for Community Behavioral Healthcare / SAMHSA /
HRSA partnered to create “Center for Integrated Health Solutions”
• States Adopting Medicaid Health Homes for SPMI (Ohio and several
others)
• Local MH Boards
• Local Foundations (eg: The Health Foundation of Greater Cincinnati)
New and Innovative Approaches at GCB
-Partnership with A Federally Qualified Health Center (FQHC) • Co-located the FQHC (The HealthCare Connection) in the BH
clinic
• Improving access to Primary Care
• 600 GCB clients receiving on-site Primary Care
• Beginning to share health information
New and Innovative Approaches at GCB
-Pharmacy Services-
• Co-located a full-service Pharmacy in the BH clinic
• Improving access to medications
• Providing BH and PH medications to over 1200
clients!
New and Innovative Approaches at GCB
Holistic Health Project – Cincinnati
• Funded by SAMHSA’s “Grants For Primary and Behavioral
Healthcare Integration”, 2 of 4 years
• Implemented:
Nurse Care Managers
Peer Wellness Coaches
Wellness Services
Primary Care Physician Consultant
• Connect clients to Primary Care
• Collecting and Reporting: height, weight, BMI, blood pressure,
fasting glucose, HgbA1c, cholesterols
• Over 700 clients enrolled
• Beginning to evaluate…
New and Innovative Approaches at GCB
-Wellness Services•
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Nutrition Group
Cooking Group
Walking Group
Losing Weight Group
Low Resistance Exercise
Chronic Disease Management (eg: diabetes)
Health Education (Women’s Health / Men’s Health)
Smoking Cessation
Health Fairs / Screening
Nurses using health education resources and tools - food
models, health promotion models (smoking dummy, diseased
lung, food portion plates, etc.
New and Innovative Approaches at GCB
-Addressing Obesity Issues with SMI Clients•
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Awarded a Mini-Pilot
5K Funded by The Health Foundation of Greater Cincinnati
Provided for supplies and educational materials
Needed to purchase a scale that measures to 1000 lbs.
Used data to target 20 clients with the highest BMI
Clients Worked with Nurses and Peer Wellness Coaches
Provided individual and group support focused on nutrition,
exercise, healthy food choices
• Tracked BMI for a 10 month period
• 68% reduced their BMI by a minimum of 2 pts
• Learning: Focused interventions for targeted health issues can
produce positive results
Integration of Care For Persons with SMI
Is Transformational Work!
• Behavioral Health Field
• States’ BH delivery systems
• BH Organizations:
GCB on our way to becoming a full Health Home 2013
to help coordinate all healthcare needs with the SMI
• Clients’ Recovery!
THANK YOU!