During the past 4 years, more than 500 patients at a Brooklyn clinic have filled out a questionnaire intended to screen for common health conditions and risks such as diabetes and smoking.
That may sound as routine as it gets in terms of a healthcare visit. But, in fact, that questionnaire is part of an innovation that aims to bridge the mind–body divide in healthcare. It’s taking shape in a southwest Brooklyn clinic called Sunset Terrace Family Health Center at NYU Langone that integrates mental health and primary care—often in the same day—for a large percentage of its patients.
Sunset Terrace—one of the 10 clinics that make up the Brooklyn-based Family Health Centers at NYU Langone—annually cares for some 3,000 patients who grapple with serious mental health problems. As is standard practice in the mental health field, patients at Sunset Terrace had always been referred to one of the other nine clinics, or to another healthcare facility, for primary care.
But that traditional division between mental and physical healthcare sometimes poorly serves patients need for coordinated care, notes Jon J. Marrelli, PsyD, NYU Langone’s program manager for behavioral health and primary care integration. “It’s well known that patients with serious mental health challenges die 15 to 25 years earlier on average, largely due to preventable reasons,” says Dr. Marrelli. “General health and mental health can interact with and reinforce one another, so a care plan should take both into account.”
One big challenge with referring mental health patients to a different facility for primary care screening and treatment is that these patients often simply don’t follow up, explains Dr. Marrelli, whether because transportation is a problem, or because patients fail to prioritize a health checkup.
Even if they do make it to a primary care clinic, he adds, they may have difficulty following the prescribed treatment plan. “It’s hard enough for those without mental illness to quit smoking, lose weight, or manage diabetes,” he says. “If you overlay depression or schizophrenia on those challenges, the barriers are much higher.”
Aided by a 4-year, $1.7 million grant in 2014 from the Federal Substance Abuse and Mental Health Services Administration, Sunset Terrace has tried to bridge the gap by establishing the Sunset Terrace Integration and Recovery (STIR) program. STIR zeroed in on smoking cessation, healthy eating, and diabetes—three very common health challenges among patients at the clinic, according to Dr. Marrelli, who directs the STIR program.
“The goal is to use assessment tools to gain insights into the primary health issues patients need help with, and then to incorporate those issues into an overall treatment plan,” he says. “Everything is tailored to achieving measurable improvements over a 12-month period.”
To help patients meet their STIR health goals, Sunset Terrace brought in a nurse practitioner, a medical assistant, and a smoking-cessation specialist to supplement its mental health staff.
Patients who enter the year-long STIR program are given an initial assessment that includes the questionnaire and measurements such as weight, waist circumference, blood sugar, and a lipids panel. Services include health-literacy classes and support groups aimed at improving nutrition, coping with diabetes, and sleep hygiene, among other health-related self-management skills. The patients are reassessed after 6 months, and then for a final time at 12 months.
By the time the STIR grant ends this fall, Dr. Marrelli expects the program will have served around 600 patients.
Outcomes for nearly 300 patients who had already completed their yearlong participation as of April have been impressive overall. “Not everyone improves,” he says, “but most have made tremendous strides.” About half the graduates improved their lipids profiles, for example, and about 20 percent of the patients with high blood pressure reversed that diagnosis by the end of the year. More than half of the patients self-reported positive outcomes for 10 out of 12 behavioral and everyday-functioning indicators, including psychological distress, overall health, and a sense of social connection.
The integrated approach is likely to remain in place at Sunset Terrace and may be supported by new grants. In fact, the push to integrate behavioral health and primary care is starting to broaden within NYU Langone overall, according to Larry K. McReynolds, executive director of Family Health Centers. That includes not only a push to have behavioral health facilities add primary care, says McReynolds, but also to have primary care facilities integrate behavioral health.
“To truly improve the health of populations and communities, medical providers have to be able to bring behavioral healthcare into all settings,” he says. “Patients shouldn’t have to go to a different location to get it.”
In that sense, the STIR program’s impact seems destined to go well beyond the 600 patients it will have directly served.