Why is Care Management Important for Mental Illness Patients?

Patients with severe mental illnesses are dying prematurely, compared with the rest of the population, mostly due to co-occurring health conditions that go untreated. Person-centered mental health homes aim to provide better care management, so that mental illness patients have access to the simple treatment that can prevent existing physical health conditions from becoming fatal.At the core of the patient-centered medical home clinical approach is team based care that provides care management and supports individuals in their self management goals. A mental health report found that care management was identified as being among the few policy options that hold promise not only of containing costs but also of improving health outcomes for high-risk populations.Care management is the coordination of care in order to reduce fragmentation and unnecessary use of services, prevent avoidable conditions, and promote independence and self-care. Alternatively called advanced care management, targeted case management, high-cost or high-risk case management, care coordination, disease management, and other terms, care management programs manifest themselves in a wide variety of ways. In some cases, care management encompasses personalized nurse counseling, pharmacy review, utilization management, case management and depression management programs. This emphasis on self-care resonates with the behavioral health system’s movement towards a recovery and resilience orientation, utilizing approaches such as the newly revised Wellness Management and Recovery program or the Wellness Recovery Action Plan. With these models, the behavioral health field has developed structured approaches that strengthen the individual’s capacity to set goals for improved self management of specific conditions and to problem solve barriers using the resources of the community and personal support systems in addition to formal services. These approaches are critical to meeting the needs of people living with serious mental illness as well as chronic health conditions.The five clinical functions of the care manager, as identified in the Health Disparities Collaborative, are:> Develop and maintain rapport with patient and provider> Educate the patient and the family> Monitor symptoms and communicate findings to provider> Develop and maintain a self-care action plan> Maximize adherence to the treatment plan through negotiation of solutions to treatment-emergent problemsUnlike disease management models with arms-length, telephonic care management, in the Chronic Care Model and patient-centered medical home the care manager is embedded in the clinical team.The community mental health centers participating in the Health Disparities Collaborative have also identified the importance of enabling services in helping engage and support individuals with chronic health conditions. These are non-medical services that facilitate access to timely and appropriate medical care, including transportation, language assistance, case management, and community outreach and education. This set of activities is ancillary to the focused care management task of monitoring health status and calibrating care for an individual and is generally not performed by the care manager. However, the team’s success in managing chronic health conditions depends on the provision of these enabling services alongside the clinical services.Care management is the key to transforming a healthcare system geared towards acute problems into one focused on addressing health needs from a longitudinal perspective (i.e., managing chronic illness and facilitating preventative self-care). Longitudinal monitoring and timely response to the course of illness is how care management transforms treatment as usual. This focus on ongoing accountability and responsibility for individuals being cared for should be distinguished from old ideas about “gatekeeping” access to care – a distinction confounded by the varying ways in which the terms care manager and case manager have been used in the last twenty years.

Linda Rosenberg is the president and CEO of the National Council for Community Behavioral Healthcare. TNC is the unifying voice of America’s community-based mental and behavioral health organizations, lobbying for mental and behavioral healthcare reform and treatment for mental illness.Lean more at www.thenationalcouncil.org.

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