Transcript Slide 1

How Peer Specialists Can Help
Consumers Reach Wellness and
Health Goals
James Schuster, MD, MBA, Community Care
Behavioral Health Organization, Pittsburgh, PA
Margaret Park, Recovery Specialist
Allegheny County Department of Human Services
September 15, 2011
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Our goals for today
• Look at the research on life expectancy for people living
with serious mental illness
• Learn what the statistics mean for real life and real
people
• Understand how peers can help consumers improve
their wellness and physical health
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Pennslyvania HealthChoices
• Medical Assistance (Medicaid) Managed Care Program
• Department of Public Welfare; Office of Mental Health
and Substance Abuse Services Oversight
• Statewide Behavioral Health Carve-Out
– 1915b Federal waiver
– County government is the recipient of funds
– County government contracting models vary
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About Community Care
• Behavioral Health Managed Care Company
• Founded in 1996
• Federally tax exempt non-profit 501(c)3
• Sole member corporation (UPMC) – provider owned
• Licensed as a Risk-Assuming PPO
• Major focus: publicly funded behavioral health
care system
• Identified BHO for Hudson Valley Region
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About Community Care
• Medicaid/HealthChoices membership: 700,000
• Commercial/Medicare membership: 430,000
• Statewide HealthChoices presence
– 36 of 67 Pennsylvania counties
• 8 offices across Pennsylvania
• More than 500 employees
• Approximately 110,000 people served
• Statewide network of more than 2,500 providers
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Community Care Counties
Erie
Warren
McKean
Tioga
Potter
Susquehanna
Bradford
Wayne
Crawford
Wyoming
Forest
Elk
Venango
Cameron
Pike
Lycoming
Mercer
Clinton
Jefferson
Clarion Jefferson
Clarion
Lawrence
Luzerne
Clearfield
Butler
Centre
Centre
Beaver
Mifflin
Mifflin
Indiana
Allegheny
Cambria
Snyder
Juniata
Juniata
Perry
Blair
Westmoreland
Columbia
Montour
Union
Armstrong
Northumberland
Monroe
Carbon
Northampton
Schuylkill
Lehigh
Dauphin
Huntingdon
Huntingdon
Washington
Berks
Bucks
Lebanon
Cumberland
Montgomery
Lancaster
Bedford
Greene
Lackawanna
Lackawanna
Sullivan
Fayette
Somerset
Fulton
Franklin
Adams
Chester
York
Philadelphia
Delaware
Community Care Office
Community Care Contract
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What Do We Know about Physical Health in
Adults with Serious Mental Illnesses?
• People with serious behavioral illness die earlier than the
general population.
• People without SMI who have risk factors common to SMI
(i.e. smoking, poverty, homelessness, obesity) also die much
earlier than the general population
• Our behavioral and physical health systems have failed to
systematically address and support prevention and wellness
across all populations, especially those which suffer from
socioeconomic disadvantages
National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and Mortality in
People with Serious Mental Illness. Alexandria, VA.
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Impact of Various Factors
• Suicide and injury account for about 30-40% of excess
mortality in people with SMI
• Sixty percent of premature deaths in persons with
schizophrenia are due to medical conditions such as
cardiovascular, pulmonary and infectious diseases.
• About 3 out of 5 people with SMI who die prematurely
die from mostly preventable diseases.
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Smoking
• Higher prevalence (56-88% for patients with schizophrenia) of
cigarette smoking (up to 44% of all cigarettes sold in US are
purchased by people with SMI)
• More toxic exposure for patients who smoke (more cigarettes,
larger portion consumed)
• Smoking is associated with increased insulin resistance
• Similar prevalence in bipolar disorder
• Smoking cessation may be the modifiable risk factor that is
likely to have the greatest impact on decreasing mortality
George TP et al. Nicotine and Tobacco Use in Schizophrenia. In: Meyer JM, Nasrallah HA, eds. Medical Illness and Schizophrenia. American Psychiatric
Publishing, Inc. 2003; Ziedonis D. Williams JM, Smelson D. Am J Med Sci. 2003 (Oct); 326(4): 223-330.
National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and Mortality in People with Serious
Mental Illness. Alexandria, VA.
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Obesity
• Obesity among persons with serious mental disorders is greater
than among the general population
• Increased incidence of Metabolic Syndrome in SMI population
• Obesity in individuals with mental disorders attributed to a number of
factors:
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a sedentary lifestyle
poor nutritional choices
lack of access to healthy food (which is also associated with poverty)
the effects of both the mental disorder itself and the medications used to treat it
lack of access to adequate preventative medical care
National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and
Mortality in People with Serious Mental Illness. Alexandria, VA.
Citromea, L., Vreeland, B., Obesity and Mental Illness. Thakore J, Leonard BE (eds): Metabolic Effects of Psychotropic Drugs.
Basel, Karger, 2009, vol 26, pp 25-46.
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Coronary Heart Disease
• The leading cause of death worldwide
• Following cardiac events, individuals with mental illness
experience a 14% lower rate of invasive coronary
interventions (47% in the case of schizophrenia) and an
11% increased mortality rate
• Despite continued improvements of care, inequalities in
the quality of care of those with mental health diagnoses
have been documented including the receipt of
preventive care
Mitchell, A.J., Lawrence, D., (2011). Revascularization and mortality rates following acute coronary syndromes in people with
severe mental illness: comparative meta-analysis. The British Journal of Psychiatry, 198, 434-441.
Hennekens C.H., Hennekens, A. R., Hollar, D., Casey, D. E., Schizophrenia and increased risks of cardiovascular disease. Am
Heart J, 2005; 150: 1115-21.
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Suicide
• Suicide is the 11th leading cause of death in the U.S. (CDC)
• An estimated 2-15% of individuals diagnosed with major
depression die by suicide
• An estimated 3-20% of individuals diagnosed with bipolar
disorder die by suicide
• An estimated 6-15% of individuals diagnosed with
schizophrenia die by suicide
• Suicide is the leading cause of premature death in those
diagnosed with schizophrenia
http://mentalhealth.samhsa.gov/suicideprevention/suicidefacts.asp
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Impact of Medications
Problems with psychiatric medications can include:
• Overweight and obesity
• Insulin resistance
• Diabetes and hyperglycemia
• Dyslipidemia
National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and
Mortality in People with Serious Mental Illness. Alexandria, VA.
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Inadequate Access to Physical Health Care
• Lack of capacity in some health care systems
• Stigma and discrimination
• Poor quality and poor provision of services in some
areas
• Lack of adequate health care coverage (in some areas)
• Monitoring and treatment guidelines are underutilized
with the SMI population (as they are in most populations)
National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and
Mortality in People with Serious Mental Illness. Alexandria, VA.
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Vulnerabilities
People with SMI are vulnerable due to higher rates of:
• Homelessness
• Victimization or trauma
• Unemployment
• Poverty
• Incarceration
• Social Isolation
National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council. (2006). Morbidity and
Mortality in People with Serious Mental Illness. Alexandria, VA.
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Why do we have shorter life spans?
• Some of the lost years of life are because of mental
health symptoms like suicide & risk-taking behavior
(30% to 40%)
• Most of the premature deaths of people with mental
illnesses are due to heart problems, strokes &
complications from diabetes. (60% to 70%)
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60% - 70%: Preventable & Treatable Illnesses
• Obesity (and antipsychotics & antidepressants can increase that
problem)
• Diabetes (atypical antipsychotics are linked)
• High cholesterol (antidepressants)
• Smoking (double the general population)
• Low rates of physical activity & exercise
• Substance use and misuse
• Lack of good medical care (‘flu’ shots, regular tests…)
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All of these problems are “synergistic”
• Smoking increases your risk of breathing problems,
allergies, colds and the ‘flu’, heart disease & cancer.
• Being overweight increases your risk of breathing
problems, diabetes, heart disease (high cholesterol &
stroke) and cancer.
• Lack of regular exercise increases your risk of
breathing problems, heart disease, diabetes, &
cancer.
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Synergistic effects cont’d
• Diabetes creates complications for all your internal
organs including your heart and lungs, kidney, liver and
makes it harder to heal from infections.
• Psychotropic Medications increase your risks of heart
disease, obesity and diabetes.
• The combination of these factors increases your risk
many times
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Let’s focus now on the Power of Peers
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What is the GOOD news?
• Adding years to life is possible! There are proven ways
of doing just that
• Developing stress hardiness-ways that work
• Choices and strengths work in wellness just as they do
in recovery
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Who, What, Where, When & How?
• Who knows more about recovery and resiliency than we
do?
• Who knows more about peer support, coaching and
sponsorship than we do?
• We can lead the way.
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Leadership characteristics
1. Leaders change things
2. Leaders act with humility
3. Leaders are not victimhood.
Leaders do no blame others,
they work with them
4. Leaders define reality through
data. Helping people measure
success
5. Leaders develop and test
changes. What works?
6. Leaders are courageous
7. Leaders persuade by being
honest, patient and persistent
8. Leaders are empowered by the
people who believe in them.
They are believable.
9. Leaders are not defeated by
negativity
10. Leaders think outside the box
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Elements to consider
• Wellness Dimensions
• Stress Hardiness (bouncing back in life)
• WRAP and Peer Support Principles
• Leadership Characteristics
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Person-Centered: Choices Matter
Used with permission from Peggy
Swarbrick
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Teaching Stress Hardiness
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Challenge-threat v opportunity, self-determination, efficacy
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Control—internal loci v. external loci, knowing which is which
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Commitment- capacity and willingness to make a commitment
Reduces risk of developing stress related health problems by
50%
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Some Principles of WRAP
• People develop hope by
making their own plans
• Each encounter focuses on the
person’s self-determination,
empowerment and choice.
• Mutual respect and
unconditional acceptance are
maintained
• ALL diversity is accepted and
support (incl. mental diversity)
• All goals and plans are
supported without judgment
• There are no pre-established
limits to recovery.
• The focus is always on what
people do well
• Informed choice is a primary
ethical determinant. Questions
are treated respectably as
valuable
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What Can We Act On?
• Many consumers have serious wellness and physical
health challenges
• If we don’t do anything about them, many people will die
at relatively young ages
• There are lots of activities and strategies that can help
consumers get healthier and ADD years to their lives
• Peers can provide leadership in these efforts and help
consumers to reach these goals
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Resources
• Reinerstsen, J.L. (1998) Physicians as Leaders in the
Improvement of Health Care Systems. American College
of Physicians, 128(10), 833-838.
• Susan Kobasa, http://stresscourse.tripod.com/id106.html
• Swarbrick, M. (2006). A wellness approach. Psychiatric
Rehabilitation Journal, 29,(4) 311- 314.
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