Hogg Foundation for Mental Health

Connecting Body and Mind for Better Health

February 1, 2009

Joann Gilbert has diabetes. In the past, unable to overcome the physical and mental barriers to managing her disease, Gilbert lost her eyesight, her job and her happiness.

But these days Gilbert has a new outlook on life, thanks to a three-year integrated health care grant awarded by the foundation to Project Vida, a community clinic in El Paso.

"I wish I had a before and after picture so you could see the difference in me," she said. "I'm not saying everything is perfect, living with my blindness isn't easy. But I can't imagine where I'd be now if it weren't for the great team that pulled together to make sure I didn't fall through the cracks."

Integrated health care seeks to improve people's health by treating their physical and behavioral illnesses together. Typically this is done by integrating, or systematically coordinating, physical and behavioral health care. Gilbert's success in managing her diabetes and depression is one of many stories from grantees that show the benefits of integrated health care.

"Many people seek help for mental health needs in primary care clinics due to lack of insurance, limited transportation, or cultural attitudes and beliefs about mental illness. However, research shows that mental illnesses often are undetected or inadequately treated in this setting," said Dr. Laurie Alexander, the foundation's program officer who is leading the initiative.

To address the problem, the foundation studied two decades of research and concluded that the "collaborative care" model improved primary care patients' mental health outcomes with a minimal investment of resources. Developed by researchers at the University of Washington and other universities, the model brings a mental health care manager and consulting psychiatrist into a primary care facility to more effectively serve clients with mental health needs.

To date the foundation has awarded a total of $2.4 million to clinics across Texas to implement the collaborative care model. Recipients include Parkland Health and Hospital System in Dallas, People's Community Clinic in Austin, Project Vida Health Center in El Paso, Texas Children's Pediatric Associates in Houston, Su Clinica Familiar in Harlingen, Nuestra Clinica del Valle in San Juan, and Brownsville Community Clinic.

Su Clinica Familiar and Nuestra Clinica developed treatment programs for adults diagnosed with depression and anxiety, especially those who also have chronic physical illnesses. "Mental illness is another consequence of chronic illness. For example, the complications of diabetes, like loss of eyesight, often cause depression," said Lucy Ramirez, Nuestra Clinica's executive director.

In Austin, People's Community Clinic used the model to enable adult clients diagnosed with depression and anxiety to receive psychiatric medication, counseling and education. The clinic has had tremendous success with the program, achieving treatment results typically seen only in controlled clinical trials.

"The key to success is our care manager, who follows up with clients to track their progress, monitor their treatment and provide support and information about their mental health condition," said Robin Rosell, clinic director of social services.

Grantees report that the care manager is the most fundamental component of their integrated care programs. This is especially true in less populated areas of the state, where there are dire shortages of mental health facilities and professionals. Even when mental health care options exist, many residents are unable to afford treatment outside the primary care setting. Stigma against seeking mental health treatment also presents a barrier that can be addressed by integrated health care.

"People have a difficult time talking to a stranger about their private matters. The care manager is crucial in forming a trusting relationship with clients," said Rachel Quintanilla, Project Vida care manager.

Bill Schlesinger, Project Vida's executive director, said that success in implementing the model required psychiatrists and care managers to establish trust with primary care physicians. Once the model is implemented, however, primary care physicians quickly see the benefits and late adopters come on board, he added.