Creative Strategies Improve Medical Care for Mentally Ill

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A new review of studies found few documented attempts, but encouraging results in the effort to improve the health and medical care of patients with mental illness.

An array of health interventions - such as providing medical evaluations at a methadone clinic - proved successful in reaching patients who might otherwise fall through the cracks.

“The main news is that these programs can be effective, that they can improve quality of primary care, that they actually improve health for these patients and that they can do so at a modest cost,” said lead researcher Benjamin G. Druss.

Druss is a psychiatrist-internist with Emory University’s Rollins School of Public Health. His team found six trials rigorous enough to include in the review.

The five studies that reported on medical quality all found significant improvement for patients in the intervention groups compared with patients that received usual care.

The limited amount of research on the issue is also news.

Druss said many studies have found that people with serious mental illness are vulnerable to receiving inadequate medical care. Earlier research shows that America’s mental health population has elevated rates of some disease and health complications from psychiatric medication, while patients tend to die at younger ages.

But the Emory review shows that few studies have taken the next step to uncover workable strategies to buffer the physical health of patients with behavior disorders, Druss said.

The review in the current edition of General Hospital Psychiatry combines data for about 1,500 patients. Most study participants were diagnosed with substance-abuse problems, while some suffered serious mental illness.

One trial provided medical evaluations at a methadone clinic, while another assembled a team of physicians and nurses to care for patients in a detox program. In one study, health workers facilitated care referrals by contacting patients’ primary care physicians to set up appointments. At one inpatient psychiatric unit, study patients were examined by a consulting internist, while other patients received usual care from the house psychiatric staff.

“When you are doing a system-type intervention - as opposed to a medication - it’s very important to tailor it to the local system,” Druss said. “The approach that will be most effective will depend on the system you are treating patients in.”

Stephen R. Marder, M.D., said the awareness surrounding the medical vulnerability of people with mental illness has not been widely translated into better medical monitoring. Marder said he’s not sure if mental-health providers are taking more responsibility for addressing the need.

But, the U.S. Veterans Affairs health system is an exception and innovator on the issue, according to Marder, a professor of psychiatry the Semel Institute for Neuroscience at the University of California Los Angeles.

“The VA has a particular focus these years in improving the quality of care. So there are some things happening,” said Marder, who was not involved in the Emory review.

Druss B., von Esenwein SA. Improving general medical care for persons with mental and addictive disorders: systematic review. General Hospital Psychiatry 28:145-153, 2006.

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