NASMHPD Report Outlines Capacity-Building Plan for Physical Health Monitoring in the Mental Health System

People with psychiatric disorders who seek help from the mental health system are routinely screened for suicide risk, and providers would be considered negligent if they failed to develop appropriate plans to address risk and prevent suicide. Yet cardiac events alone account for more deaths than suicide in this population, and few mental health agencies have instituted screening and prevention protocols for cardiovascular disease and other chronic illnesses, which together account for 87% of years of life lost among people with mental illness.

A new report by the National Association for State Mental Health Program Directors (NASMHPD) takes an important step in addressing this serious gap in care. It outlines an ambitious plan for creating systematic capacity to collect physical health data that will inform the clinical care of each person served in the mental health system and to aggregate such data in ways that will allow close monitoring of the health of this population. Because the vital capacity building described in the report cannot be undertaken without strong leadership, the report also recommends steps to engage public health and health care agencies and officials at national, state, and local levels.

Noting that "What gets measured gets done," the authors propose the provisional adoption and feasibility testing of a single set of consumer-oriented indicators for all parts of the mental health system. Ten health indicators and two process indicators are proposed, along with sites for testing them. The ten health indicators are personal history of diabetes, hypertension, and cardiovascular disease; family history of diabetes, hypertension, and cardiovascular disease; weight, height, and body mass index; blood pressure, blood glucose or HbA1c; lipid profile; tobacco use and history; substance use and history; medication history and current medication list, with dosages; and social supports. The two process indicators are screening and monitoring of health risk and conditions in mental health settings and access to and utilization of primary care services (medical and dental).

The report recommends that NASMHPD authorize an "environmental scan" of all state mental health agencies to asses their current activities and data in light of the proposed indicator set. NASMHPD is also directed to authorize a proposal to support pilot testing on the basis of states' interest and willingness to participate.

To further the goal of monitoring health at the population level, the report recommends the adoption of proven population surveillance tools currently in use in the field of public health and application of these tools to mental health surveillance. To this end the report calls on NASMHPD to revise the Mental Health Statistics Improvement Program's Consumer-Oriented Report Card to include selected indicators from the Behavioral Risk Factor Surveillance System (BRFSS) and other sources. It is also recommended that the Centers for Disease Control and Prevention incorporate validated mental health surveillance instruments into its BRFSS annual survey. Specifically mentioned are the K6, which measures serious psychological distress, and the Personal Health Questionnaire (PHQ-9), which assesses depression severity (both brief instruments are included in the report's appendix).

Another focus of the report is the need to create a "patient-centered medical home" for individuals living with mental illness. The medical home would bring together a primary care physician, the bio-psychosocial-spiritual model of care, behavioral health services, and disease management strategies based on the chronic care model.

Collaborative care could occur in a "virtual" health care home, rather than a single physical location, where everyone involved in a person's care would coordinate their services and specify responsibility for care management activities.

The 37-page report, Measurement of Health Status for People With Serious Mental Illnesses, is the result of a collaborative effort developed jointly by the NASMHPD's Medical Directors Council and its National Research Institute (NRI) and the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration (SAMHSA). It is based on a literature review, work group meetings of the Medical Directors Council, and a two-day meeting of medical directors, consumers, NRI researchers, SAMHSA representatives, academic researchers, and other technical experts. The report is available at www.nasmhpd.org .