When people talk about an illness, they usually base their ideas on the symptoms, or signs of that illness. For instance, colds can include stuffy noses, scratchy throats, and lowered energy. Flu can include fever, chills, and stomach upset. More serious illnesses, such as heart disease or cancer, also have a variety of physical indicators associated with them – some only detectible through testing.
When people talk about psychiatric illness, there are also specific symptoms associated with different illnesses. Depression carries with it sadness, loss of motivation, and loss of pleasure. Bipolar Disorder may include mood swings and vulnerability to substance abuse. Schizophrenia may include hallucinations and delusions. However, people sometimes do not consider the physical symptoms associated with psychiatric ailments. For instance, Bipolar Disorder is often associated with sleep and appetite disturbance, and Depression is highly correlated with physical pain. The symptom clusters associated with psychiatric illness don’t stop at the neck.
What many folks don’t realize is that individuals coping with psychiatric illness are also at heightened risk for physical illness. In fact, individuals who have been diagnosed with severe and persistent mental illnesses have a mortality rate that is significantly in excess of the general population, placing average age of death 20-25 years younger than folks who are not dealing with these illnesses. This startling fact is a consequence, for most individuals dealing with these diseases, of dramatically increased prevalence of illnesses such as diabetes, heart disease, and cancer. As with mental illness itself, some of the reason is genetic – but some appears to be environmental. That means there is some possibility for improvement, not only with new treatment – but with increased treatment.
Individuals suffering from severe and persistent mental illnesses have some of the lowest rates of primary care utilization (and the highest rate of emergency room utilization) of almost any group. The problem seems to be getting primary care services to the folks who need them, but often have trouble accessing them. That way, preventive care can take the place of more costly and difficult emergency care.
One barrier to access has been the separation of the community mental health system from the community health system.
In Leon County, Apalachee Center and Bond Community Health Center have been trying something new. For the past two years, a federal SAMHSA grant has been funding a satellite site for Bond at Apalachee Center’s outpatient clinic in Leon County. The Bond Apalachee Wellness Integration Clinic (BAWIC) has served 453 Apalachee clients over the past 2 years. Apalachee Center clients in Leon County can now receive their primary health care and their psychiatric care on the same day at the same place. Clients have reported a high level of satisfaction with the staff and services of BAWIC.
Client comments on the satisfaction questionnaire noted: “Everyone is extremely helpful and friendly,” “I can get all my healthcare in one building the same day (mental, health and counseling,)” and “I like the services and convenience of seeing my primary care doctor and psychiatrist in one place.”
At the end of the day, healthcare is healthcare, whether doctors are treating the heart, the stomach, the teeth – or the brain.
When folks who are coping with multiple issues can get the services they need quickly, simply, and in one place, they win – and so does the whole community.
Jay Reeve, PhD, is the President and Chief Executive Officer of Apalachee Center, Inc., a large community mental health center in Tallahassee, Florida, serving approximately 6,000 clients annually. Dr. Reeve holds degrees from Tufts, Harvard, and Adelphi Universities. He has been a licensed clinical psychologist since 1993. He has published on topics ranging from the psychotherapeutic treatment of HIV+ children to clinical supervision of interns, and has been a frequent commentator for the ABC News Medical News Group. He is currently on faculty at the FSU Department of Psychology.
by Jay Reeve, PhD & Sue Conger
Dr. Jay Reeve,
CEO of Apalachee Center
Sue Conger, MSW