Coordinate care for physical, mental health issues

Each condition can affect the other

Healthcare organizations are recognizing that medical problems and mental health conditions often are intertwined and that each condition exacerbates the other. Organizations are taking steps to improve communication between mental health and physical health providers.

A tremendous body of research shows the connection between physical and mental health. For instance, in the Preventing Chronic Disease journal published by the Centers for Disease Control and Prevention (CDC), Daniel P. Chapman, PhD, and colleagues wrote that a review of published materials showed that mental illnesses were associated with increased prevalence of chronic diseases and that the association "appears attributable to depressive disorders precipitating chronic disease and to chronic disease exacerbating symptoms of depression."1

Their review of articles showed that nearly 50% of asthma patients may have significant depressive symptoms and that 87.5% of people who have frequent asthma attacks manifest psychopathology compared with 25% of persons with less frequent attacks. They wrote that research shows that people who are depressed are more likely to develop coronary artery disease and that people with significant depression are twice as likely to have a stroke as people with fewer symptoms and more than four times as likely to have a myocardial infarction as people with no history of depression.

The National Center for Disease Prevention and Health Promotion at the CDC calls for including mental health promotion as part of its efforts to prevent chronic disease in the report, "The Public Health Action Plan to Integrate Mental Health and Promotion and Mental Illness Prevention with Chronic Disease Prevention 2011-2015."

"The interconnections between chronic disease, injury, and mental illness are striking," the report says.2

People with behavioral health conditions die on average 25 years earlier than the general population because they tend to smoke more, be more overweight, and suffer from chronic obstructive pulmonary disease, according to Sue Bergeson, vice president of consumer affairs for Optum, a health services company based in Eden Prairie, MN.

"They spend so much time with psychiatrists and other behavioral health professionals that they don’t see their primary care provider and deal with their physical conditions, such as diabetes and chronic obstructive pulmonary disease," she says. People with behavioral health conditions smoke 44% of all cigarettes and may be taking medications that make them gain as much as 30 pounds a year, she adds.

"Many people who have behavioral health issues don’t adhere to their treatment plan because, like other people with chronic illnesses, they don’t like to admit that they have a condition they have to treat for the rest of their lives. In addition to coping with their condition, they have to cope with the stigma of mental illness and don’t take their medication because they feel ashamed to have the condition. Sometimes they stop taking their medication because they feel better or don’t like the side effects of their medication and suffer a relapse," she says.

To help people who have been hospitalized for a psychological condition remain out of the hospital, Optum’s Field Care Advocates — licensed, community-based clinicians — work with people who are at risk for rehospitalization for behavioral health issues to ensure that they receive adequate therapeutic support and that they are receiving care for their medical comorbidities. They support the individuals on following their treatment plans and promote communication between the patients’ medical and behavioral health providers. Patients who need extra help are paired with a peer specialist, who assists the patients in making lifestyle changes. (For more on Optum’s program, see related article on page 89.)

Recognizing that behavioral and physical healthcare systems often lack coordination which can result in a negative impact on individuals, UPMC Insurance Division developed Connected Care, a program that links behavioral health providers and medical providers, says James Schuster, MD, chief medical officer for Community Care Behavioral Health Organization. The program provides coordination of mental health and physical health benefits for members of UPMC for You, a Medicaid managed care plan, as well as Community Care Behavioral Health for its behavioral health services. Case managers from both organizations have access to a shared database with information on all the care patients receive, and they meet regularly to brainstorm on difficult cases. (For details, see article on page 90.)

"People with serious mental illness have significantly shorter life expectancies than the rest of the population. Many are impoverished, and their illness often prevents them from taking medication as directed and making the lifestyle changes that would improve their physical health. Coordination of the mental and physical health services is a key to helping them improve their health," he says.

Licensed behavioral health clinicians in the behavioral health unit of Aetna’s Disability and Absence Management Services coordinate behavioral health interventions for employees with a primary or secondary diagnosis of a mental health issue that may impact the member’s return-to-work.

"We look at the person holistically and deal with more than just the primary medical condition. When the medical disability management unit uncovers a psychiatric issue, the claims are referred to a behavioral health clinician for review and consultation to identify any psychosocial issues that can impede treatment and lengthen the time it takes for the employee to return to work," says Adele Spallone, LMHC, LMFT, clinical services head for Aetna Disability and Absence Management services.


1. Chapman, DP, Perry, GS, Strine, TW. The vital link between chronic disease and depressive disorders.