APHA ChicagoAPHA ChicagoNovember 2, 2015November 2, 2015

Special Session Abstract of the Mental Health Division: Special Session Abstract of the Mental Health Division:

Improving health outcomes among individuals with Improving health outcomes among individuals with serious mental illnessesserious mental illnesses

Presentations:Presentations:

Improving health outcomes through use of disease registries and care coordination for Improving health outcomes through use of disease registries and care coordination for patients with co-occurring diabetes and mental illnesspatients with co-occurring diabetes and mental illness. Judith A. Cook, Ph.D and Pamela . Judith A. Cook, Ph.D and Pamela

Steigman, M.A.Steigman, M.A.

Community health screening and its role in public health and psychiatric epidemiologyCommunity health screening and its role in public health and psychiatric epidemiology. Lisa . Lisa A. Razzano, Ph.D., Jessica A. Jonikas, Ph.D. and Peggy Swarbrick, Ph.D. OT. A. Razzano, Ph.D., Jessica A. Jonikas, Ph.D. and Peggy Swarbrick, Ph.D. OT.

A randomized trial to improve health and wellness among a public mental health sample of A randomized trial to improve health and wellness among a public mental health sample of individuals with severe mental illnessindividuals with severe mental illness. E. Sally Rogers, Sc.D. and Mihoko Maru, M. A., . E. Sally Rogers, Sc.D. and Mihoko Maru, M. A.,

M.S.W.M.S.W.

The Recovery Center: A model designed to promote health and wellness through The Recovery Center: A model designed to promote health and wellness through education and coaching.education and coaching. Dori Hutchinson, Sc.D. Dori Hutchinson, Sc.D.

  

Discussant: Discussant: Crystal Blyler Ph.D. Mathematic Policy InstituteCrystal Blyler Ph.D. Mathematic Policy InstituteAAuthors have no conflicts of interest to declare.uthors have no conflicts of interest to declare.

Community Health Screening & Its Role in Community Health Screening & Its Role in Public Health & Psychiatric EpidemiologyPublic Health & Psychiatric Epidemiology

Lisa A. Razzano, PhD, CPRPLisa A. Razzano, PhD, CPRPAssociate Professor of PsychiatryAssociate Professor of Psychiatry

Deputy DirectorDeputy Director

Center On Mental Health Services Research & Policy Center on Psychiatric Disability & Co-Occurring

Medical Conditions

Annual Meeting of the American Public Health Association

02 November 2015

AcknowledgmentsAcknowledgments

UIC National Research & Training Center on UIC National Research & Training Center on Co-Occurring Medical ConditionsCo-Occurring Medical Conditions USDOE- NIDRR & SAMHSA; H133G100028; USDOE- NIDRR & SAMHSA; H133G100028; H133G010093H133G010093

The views and ideas expressed herein do not The views and ideas expressed herein do not reflect the policy or position of any Federal reflect the policy or position of any Federal

Agency or private corporation. Agency or private corporation.

Today’s Learning GoalsToday’s Learning Goals Learning Objectives for

the Special Session: Attendees will describe the

leading causes of mortality and morbidity among individuals with mental illness;

  Attendees will describe ways

to modify the practice of community health fairs for research purposes and for participants with serious mental health disorders.

Health People 2020: Defining disparities …Health disparities adversely affect groups of

people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.”

U.S. Department of Health and Human Services. The Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020. Phase I report: Recommendations for the framework and format of Healthy People 2020. Section IV. Advisory Committee findings and recommendations. Available at: http://www.healthypeople.gov/hp2020/advisory/PhaseI/sec4.htm#_Toc211942917. Accessed 1/6/10.

High Rates of Morbidity & MortalityHigh Rates of Morbidity & Mortality

Mortality – – On average, people with SMI die 25 years earlier than the general population and this excess is increasing

• 60% of deaths are due to preventable and treatable medical conditions like cardiovascular disease, diabetes, and high blood pressure

What Do We Know?What Do We Know?

Morbidity – People in recovery have significantly poorer physical health & more co-occurring health conditions than the general population• In one study, among 200 people

schizophrenia and affective disorders, odds of diabetes, lung diseases, and liver problems were significantly elevated compared to matched subsets from the general population

Sokal et al.

Diabetes Cardiovascular

Diseases Hypertension,

High Cholesterol Renal/Kidney

Diseases Liver Diseases (non-

viral/non-hepatitis)

Infectious DiseasesHIV, Hepatitis B

& C, Tuberculosis Respiratory

Conditions COPD, Asthma,

Smoking-related conditions

Co-Occurring ConditionsPeople in recovery have higher rates of…

Additional Risks from Substance Use

Co-occurring substance abuse increases risk of: heart disease asthma gastrointestinal disorder acute respiratory issues infectious diseases skin infections incarceration

Internal & Personal Factors Unhealthy lifestyles Low motivation for

medical treatment Fearfulness Limited health literacy Unemployment Past incarceration Mental health issues

that impact incidence & management of illness

Provider Factors Triggering Vulnerabilities

Medical provider discomfort & inexperience with people in recovery

Lack of training about mental illness & recovery

Stigma

Clinical Factors Leading to Health Vulnerabilities

Relationship between use of psychotropic medications & poor medical outcomes

Limited or poor medication adherence

Ambivalence Low health literacy Side-effects Depression

Systematic Factors Triggering Vulnerabilities

Bifurcation of medical & mental health systems

Cumbersome funding policies

Overemphasis on acute care versus prevention • Many medical conditions are

preventable or treatable • But, current services lack

adequate screening for early detection & intervention

Health Assessment What are the person’s health strengths?

Past success with a wellness goal (big or small)?

What will be the personal benefit from meeting a health goal?

What are the person’s health risks?How do past and/or current behaviors impact on

progression or severity of current illnesses (harm reduction)?

How do past or current health behaviors increase vulnerability to or risks for new illnesses (prevention)?

What is the person’s current health status?

What is Health Screening? Evaluation of health status & Evaluation of health status &

potentialpotential Looking for current disease or Looking for current disease or

greater-than-normal riskgreater-than-normal risk Can includeCan include

• personal & family health personal & family health history, physical exam, lab history, physical exam, lab tests, radiological examtests, radiological exam

• can be followed by can be followed by counseling, education, counseling, education, referral, or further testing referral, or further testing

http://medical-dictionary.thefreedictionary.com/http://medical-dictionary.thefreedictionary.com/

Value of Health Screening

Provides important epidemiologic dataProvides important epidemiologic data Can positively affect health beliefs & Can positively affect health beliefs &

perceptions, including feelings of control perceptions, including feelings of control over one’s health (self-efficacy)over one’s health (self-efficacy)

Serves as a “cue to action” by engaging Serves as a “cue to action” by engaging people in health promotion effortspeople in health promotion efforts

Can lead to better linkage to collateral Can lead to better linkage to collateral treatment and services treatment and services

Common Health Screening Tests History of known illnesses (NHANES) Body Mass Index

Height, weight, waist, circumference Diabetes Blood Pressure Cholesterol & Triglycerides Heart Health Smoking & Use of Nicotine Use of Alcohol Use of Recreational Drugs, Misuse of Prescription Medications

Take a Look!Free download: Free download: http://www.cmhsrp.uic.edhttp://www.cmhsrp.uic.edu/health/index.aspu/health/index.asp

Preliminary Findings

4 events 4 events Participants from sites in NJ, IL, MD, & GAParticipants from sites in NJ, IL, MD, & GA Demographics (N=457)Demographics (N=457)

• 51% male• 80% high school education or greater

• 49% White; 39% Black; 4% Multi-Racial; 2% Asian; 1% American Indian/Alaskan Native; 7% Other

7% Latino/Hispanic Cook, Razzano, Jonikas et al. (2015). Health risks and changes in self-efficacy . . . Cook, Razzano, Jonikas et al. (2015). Health risks and changes in self-efficacy . . .

Preliminary Findings

• 41% living with schizophrenia, 23% with bipolar disorder, 24% with depression, 12% with other psychiatric diagnoses

• 89% using psychiatric medications• 78% insured through Medicaid,

Medicare, or both• 14% reported no insurance coverage

Cook, Razzano, Jonikas et al. (2015). Health risks and changes in self-efficacy . . . Cook, Razzano, Jonikas et al. (2015). Health risks and changes in self-efficacy . . .

Health Risks DetectedHealth Risks DetectedUIC Health Fair Participants U.S. Population

82% obese/overweight 68%

7% high cholesterol 13%

14% A1C diabetes 2%

32% high blood pressure 29%

62% dependent on nicotine 57%

17% at risk - alcohol dependence 8%

4% at risk - drug dependence 2%

10% high risk - heart attack 3%

Cook, Razzano, Jonikas et al. (2015). Health risks and changes in self-efficacy . . . Cook, Razzano, Jonikas et al. (2015). Health risks and changes in self-efficacy . . .

Study Findings - 1 Overall, a higher proportion of Overall, a higher proportion of

participants screened positive for health participants screened positive for health risks compared to rates for those in the risks compared to rates for those in the U.S. adult general population.U.S. adult general population.

In some cases, rates of health risk were In some cases, rates of health risk were commensurate with general population commensurate with general population estimates due to the higher number of estimates due to the higher number of individuals in recovery diagnosed with individuals in recovery diagnosed with chronic health conditions, but who also chronic health conditions, but who also are managing them both with are managing them both with pharmacological interventions and pharmacological interventions and services supports.services supports.

Health Scale FindingsResults of Multivariable Random Regression Analyses:

Measures of Health Attitudes

Measure(s)RRM

EstimateZ

score significance

Self-Rated Abilities for Health Practices 0.71 3.26 .001

Perceived Competence for Health Maintenance 1.27 5.04 < .001

Multidimensional Health Locus of Control Factors

Internal ControlPowerful Others

Chance

0.561.730.28

2.295.110.95

.02.001ns

Results also support that simple Results also support that simple health fair screenings and activities health fair screenings and activities can affect change in specific health can affect change in specific health attitudes and self-rated health attitudes and self-rated health abilities as measured with standard abilities as measured with standard indicators. indicators.

Study Findings - 2

Creating & Sustaing a“Health Community”

Provide health information activities Provide health information activities • Expose people to assets with which they may Expose people to assets with which they may

have limited experience have limited experience • Wii Fit, on-line fitness communities, shared Wii Fit, on-line fitness communities, shared

decision making wellness workstations, decision making wellness workstations, simple meal planssimple meal plans

• Invite local nurses, doctors, blood banks, Invite local nurses, doctors, blood banks, pharmacists, etc. to present at luncheonspharmacists, etc. to present at luncheons

• Collaborate with wellness & health providers for Collaborate with wellness & health providers for on-site demonstrations on-site demonstrations

• Massage, Reiki, Yoga, Pilates, etc. Massage, Reiki, Yoga, Pilates, etc. • Celebrate & build on “established” health Celebrate & build on “established” health

monthsmonths

Regular Health Screening

Include a comprehensive medical/health history at intake & ongoing in services

• Include assessment & identification of health protective behaviors and risks

• Prepare people for ongoing nature of these discussions; normalize focus on health & health behaviors

• Identify & address barriers to personal health risk awareness

Acute mental health symptoms can affect ability to provide accurate information

Facilitate Health Education

Help people learn about health risks & how to reduce the potential for harm

• Assess existing knowledge & strengths • Go slowly, work at the individual’s pace• Don’t educate during a crisis or when the

person is distressed• Simplify information & present it in small

pieces • Repeat the information• Keep a persistent focus on physical health

Keep in mind that… Individuals experience multiple obstacles

that affect their ability to achieve good health

Must consider the combined impact that social determinants have on health outcomes of specific populations

Study PublicationsStudy Publications Cook, J.A., Razzano, L.A., Swarbrick, M.A. et al. (2015). Health risks and

changes in self-efficacy following community health screening of adults with serious mental illnesses. PLoS ONE 10(4): e0123552. doi:10.1371/journal.pone.012355.

Razzano, L.A., Cook, J.A., Yost, C. et al. (2014). Factors associated with co-occurring medical conditions among adults with serious mental disorders. Schizophrenia Research, DOI: http://dx.doi.org/10.1016/j.schres.2014.11.021.

Swarbrick, M., Cook, J.A., Razzano, L.A. et al. (2013). Health screening dialogues. Journal of Psychosocial Nursing and Mental Health Services, 51(12), 22-8

Reaching Us at the Center….

http://www.cmhsrp.uic.edu/health/index.asp