Tuesday, April 9, 2013

You are invited to participate in our monthly Twitter chat on Wednesday, April 10, with members of Altarum on topics about Behavioral Health. We invite experts to address particular topics and conduct an open forum on the second Wednesday of each month from 1:00 – 2:00pm ET. This month, #BHchat honors National Minority Health Month with guest Laura Yager, Director of Partnerships and Resource Development for the Fairfax-Falls Church Community Services Board in Fairfax County, Virginia.

Photo of two young menPeople with serious mental illnesses die, on average, 25 years earlier the general population—largely due to preventable illnesses, such as cardiovascular disease and diabetes.

In fact, a study done by the National Association of State Mental Health Program Directors showed that three out of every five people with serious mental illness die from a preventable health condition. (source

A variety of factors can contribute to this disparity, such as weight gain from psychotropic medications or anxiety stemming from visits to fast-paced or crowded medical facilities. Also adding to this disparity are higher rates of risk factors, including tobacco and alcohol use, as well as lower incomes that limit access to quality care.

As we celebrate Minority Health Awareness Month in April, it is important to note the behavioral health disparities, specifically among African Americans and American Indians/Alaskan Natives (AI/AN). African Americans are more likely to experience mental illness than their white counterparts and less likely to seek treatment. AI/ANs suffer disproportionately from depression and substance use disorders and are over-represented in inpatient care. (source)

These statistics reinforce what we already know, the underlying risk factors that contribute to health disparities are a result of systemic and unequal distribution of the social, economic, and environmental conditions necessary for good health. Inequities, found in almost all aspects of the health care system, lead to health disparities—differences in health status between groups of people.

When it comes to behavioral health research and best practices, strong evidence shows that access to quality integrated care for individuals with serious mental illness leads to positive outcomes across the spectrum of physical and emotional health. The Fairfax-Falls Church Community Services Board  in Fairfax County, Virginia, has embarked on such a journey, to transform its health system into one of integrated care for people living with mental illness or other behavioral health challenges. Situated just west of Washington, D.C., and home to more than 1 million people, Fairfax County is the most populous jurisdiction in Virginia and one of the most diverse. With more than 100 different languages spoken in the county, 37 percent of its residents report speaking a language other than English at home.

Access to health care is a top priority in Fairfax County, and improving that access is part of creating "whole health" opportunities for residents who receive behavioral health services. The county is focusing on two separate models to provide integrated care.

The first model integrates primary health into an existing behavioral health center. This will involve opening a health clinic within one of the county’s community mental health sites in cooperation with a federally qualified health center (FQHC), Alexandria Neighborhood Health Services, Inc.. By ensuring a diverse payer mix, including people with insurance and those with Medicaid/Medicare, the county has created a sustainable design for offering integrated health care services in a location that is already familiar to people within the system. In addition, the county’s Community Health Care Network, providing health services for uninsured, supports this model by prioritizing services for those eligible who have mental illness and are low income residents. This partnership contributes greatly to a sustainable model.

The second model employed by Fairfax County involves the integration of behavioral health into a primary health care setting. When FQHC Healthworks for North Virginia received New Access Point funding from the Health Resources and Services Administration to develop a site in the northern part of Fairfax County, county behavioral health staff were at the table as a partner providing in-kind support. They agreed to provide the health center with onsite mental health services for people with serious behavioral issues that are not easily addressed in typical primary health care settings. The health center is providing office space and collaboration with other behavioral health staff. This collaboration will provide a gateway to behavioral health services for those eligible, while also offering a primary health care site for individuals with behavioral health needs.

To further embrace the holistic needs of the individuals served, Fairfax County offers onsite pharmacy services and focuses on health promotion, which will ultimately transform an old "community mental health" site into a "wellness center" to include such things as exercise, tobacco cessation programs, recovery supports, and other health promotion activities.

What makes Fairfax County’s efforts unique is their approach to health care integration. Many primary and behavioral integration models focus solely on people with serious mental illness. The county’s primary health integration focuses on access for all people served by the agency. This includes people with behavioral health issues like mental illness and substance use disorders, as well as people with intellectual disabilities. Instead of being segregated by disability focus, health care is accessible to all. While this may be a different way of looking at integration, it is a more natural way to consider health.

Fairfax County demonstrates that holistic health care for individuals with behavioral health issues is achievable through collaboration and well-planned systems change. Learning from these comprehensive models, we can attend to all individuals in need—managing and reducing risk factors, addressing co-occurring disorders, and preventing and curing the illnesses that can be. Working together, we can eliminate behavioral health disparities no matter how diverse the population, which will call for a real celebration during Minority Health Awareness Month!

All postings to the Health Policy Forum (whether from employees or those outside the Institute) represent the views of the individual authors and/or organizations and do not necessarily represent the position, interests, strategy, or opinions of Altarum Institute. Altarum is a nonprofit, nonpartisan organization. No posting should be considered an endorsement by Altarum of individual candidates, political parties, opinions or policy positions.


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