The term “medical home” has become a health reform buzzword. But a new model of care for patients with severe mental illness has lately emerged: the mental health home.
“The [mental health home] model of care incorporates medical home characteristics,” wrote Dr. Thomas E. Smith and Dr. Lloyd I. Sederer in a recent paper (Psychiatric Services 2009:60;528-33).
“The key characteristics of the medical home model involve commitment to the management of chronic illness, involvement of the individual and family/support system at all times, multidisciplinary collaboration, and coordination of services. These are exactly the principles we want to emphasize with our 'mental health home' approach,” said Dr. Smith, of the department of psychiatry at Columbia University, New York, in an interview.
But there are key differences. For one, in the mental health home–a term Dr. Smith and Dr. Sederer coined–the care is coordinated by a psychiatrist or other mental health physician, not a primary care doctor.
That does not mean psychiatrists will treat medical conditions. “They will, however, be much more active in monitoring basic health and wellness indicators in their patients with serious mental illness.” And considering that psychiatric treatments are often associated with weight gain, metabolic syndrome, diabetes, and obesity, “I think the onus is on the mental health provider to pay attention to some of these primary care issues,” he added.
The second difference between the proposed mental health home and the conventional medical home model is that the former would target a very exclusive group of patients: the seriously mentally ill.
“This is not for the entire mental health population,” Dr. Smith said. It would service “a population that in most states are treated within the public mental health system, either state-run clinics or clinics that bill for state services.”
The people who are cared for in these settings primarily have diagnoses like schizophrenia, bipolar disorder, or severe depression, with significant disability.
“These are [patients] who don't engage well; they don't follow up and aren't advocates for their own care… These people don't have family doctors. They have a hard enough time following up with their mental health care, never mind their primary health care,” he added.
The goal of the paper, said Dr. Smith, was to introduce the concept of a mental health home as being a complement–not replacement–to the medical home model, and to “get people thinking about how these principles could be applied to the care and of the seriously mentally ill.”
Neither Dr. Smith nor Dr. Sederer, who is with the medical director of the New York State Office of Mental Health, disclosed any conflicts of interest.
Payment Urged for Pediatricians Who Administer Mental Health Care
A new joint paper urges reimbursement for pediatricians who screen and treat patients for mental illness in the “medical home” setting.
That's because pediatricians, can and should act as effective “portals of entry” into specialty mental health treatment, according to the authors. They therefore deserve “payment for assessment and treatment of mental health problems [that is] adequate and comparable with payment for services addressing other medical illnesses,” according to the American Academy of Child and Adolescent Psychiatry and the American Academy of Pediatrics.
“Furthermore, payment must be proportionate to the complexity of the situation and the additional time and work required in managing mental health conditions,” the statement said (doi: 10.1542/peds.2009-0048).
The statement is at least partly a reaction to the ongoing shortage of child and adolescent psychiatrists, which “makes coordination of treatment between primary care physicians, and child and adolescent psychiatrists paramount,” said AACAP President Robert Hendren, D.O., in a statement.
The report adds that although “almost one in five children in the United States suffers from a diagnosable mental disorder, only 20%-25% of affected children receive treatment.”
The paper was supported by an “Improving Mental Heath in Primary Care Through Access, Collaboration, and Training (IMPACT)” grant from the U.S. Department of Health and Human Services.