Increasing access with integrated whole-health care

Four community mental health centers (CMHCs) are integrating physical health into behavioral health homes, and one of those centers shared the following story, which highlights the value of integrated care to one patient, who has severe bipolar disorder, a history of significant drug and alcohol use and has experienced chronic homelessness.

This patient was receiving periodic primary care in a federally qualified health center (FQHC) from a primary care provider to address complicated medical issues, intoxication, emotional dysregulation and mania. The patient was frequently referred to a CMHC and became frustrated by what felt like a tangled and disjointed bureaucracy until late 2015 when the Boulder Integrated Health Home (IHH) opened and began to offer whole-person care through a partnership between Mental Health Partners (CMHC), Clinica Family Health (FQHC) and Dental Aid.

One of the cornerstones of the Boulder IHH is easy access for individuals in need. In this patient’s case, the entrance point was primary care. The patient’s primary care provider at the FQHC encouraged the patient to schedule a primary care appointment at the Boulder IHH and the client agreed to give it a try. The Boulder IHH’s behavioral health professional (BHP) joined the appointment and enrolled the patient with Mental Health Partners. The BHP, who helped coordinate regular, flexible meeting times for therapy, also spent time building trust and explaining the Boulder IHH’s unique model, which included physical and behavioral health. While the patient was initially reluctant to engage in mental health care, given the lack of success in the past, and did not want to meet with the IHH’s psychiatrist, the patient agreed to meet with the psychiatrist after discussing the meeting with the behavioral health and primary care providers, whom the patient had grown to trust. The providers introduced the patient to the psychiatrist and sat in on the first few appointments. Boulder IHH staff and providers consulted frequently about care for the patient, who agreed to a weekly psychiatric medication shot and monitored medications. The patient had great difficulty remembering to take them otherwise.

Initially drawn to the welcoming, open environment of the IHH’s location at Mental Health Partner’s Ryan Wellness Center, the patient enjoyed eating lunch at the onsite Chinook Café and socializing with others. The patient began to engage in some of MHP’s wellness classes, including whole-health self-management models, art and poetry workshops, yoga and hiking groups, and coping with co-occurring mental health and substance use issues.

The patient maintained regular appointments with the primary care provider and a therapist, who were flexible and worked with the patient to reduce lateness or last-minute rescheduling. There were setbacks, which is common for individuals with serious mental illness, but they did not derail progress.

After a year of regular appointments with the providers and psychiatrist, the patient received a permanent, supported housing voucher and the psychiatric medication shot received weekly has helped reduce drinking and drug use. “One or two shots and then I just don’t feel like drinking more,” the patient told providers.

The patient’s mood/mania instability was driving some of the substance misuse, and the patient struggled to get the mood/mania under control not taking medications reliably, due to the substance use.

After years of homelessness, serious infections and other health consequences of drug use, many life-threatening illness and injuries, the patient remains in stable housing and is building resilience to increase the patient's ability to deal with setbacks, including substance relapse and chronic condition complications. The patient is smart, social, compassionate, an avid reader, has a good sense of humor, and family ties that help support recovery.