Behavioral Health: Understanding the Impacts on Physical Health and Wellbeing Ranota T Hall MD September 25, 2015
Behavioral Health DEFINITION... An umbrella term and refers to a continuum of services for individuals at risk of, or suffering from, mental, behavioral, or addictive disorders..as a discipline refers to mental health, psychiatric, marriage addictions treatment Source: Center for Prevention and Health Services, An Employer s Guide to Behavioral Health Services; National Business Group on Health, 2005.
Behavioral Health DEFINITION... "Behavioral health" is a general term that encompasses the promotion of emotional health; the prevention of mental illnesses and substance use disorders; and treatments and services for mental and/or substance use disorders. Source: Glossary of Terms and Acronyms for SAMHSA Grants; SAMHSA.gov/grant/grants-glossary.
What is it?
RESULTS OF ENGAGEMENT Blood sugar was elevated upon screening and proper treatment for newly diagnosed Diabetes initiated Started a smoking cessation program Elevated cholesterol and triglycerides were evaluated and changes in his medication for his mood problems made
RESULTS OF ENGAGEMENT BP was elevated EKG was ordered and found to be abnormal Referred to a Cardiologist for further evaluation He was referred for a wellness/healthy lifestyles program to promote weight loss and changes to his diet
RESULTS OF ENGAGEMENT He was referred for a Substance Use Disorder evaluation, education and treatment along with his wife He was referred to a therapist for best practice treatment of his depression (CBT) He and his wife have started couples/family therapy
The Numbers Individuals with Severe Mental Illness (SMI) have mortality rates 2 to 3 times higher than the general population Source: World Psychiatry, Journal of the World Psychiatric Association, Vol 10, Feb. 2011, p. 51-77, Hert et al.
The Numbers The result is a 13 to 30 year shortened life expectancy The shortened lifespan is found to be related to physical illness Source: World Psychiatry, Journal of the World Psychiatric Association, Vol 10, Feb. 2011, p. 51-77, Hert et al.
The Numbers Individuals with a diagnosis of Schizophrenia Higher rates of alcohol, tobacco and drug abuse 41% of a national study reported both MI and active tobacco use (twice as high as seen in those without MI) Some studies show a 90% rate of tobacco use Source: World Psychiatry, Journal of the World Psychiatric Association, Vol 10, Feb. 2011 p,. 51-77 Hert et al.
The Numbers The prevalence rate of Diabetes in the SMI population for those with Schizophrenia or Bipolar illness is up to 3 times higher compared to the general population The rates for individuals with MDD for DM can be up to 3 times as great as that for the general population Source: World Psychiatry, Journal of the World Psychiatric Association, Vol 10, Feb. 2011, p. 51-77, Hert et al.
The Numbers Cardiovascular Disease Accounts for 17.1 million deaths worldwide (about 29%) 82% of CV deaths occur in developing countries What are typical contributors?» Smoking» Low exercise» Weight gain/obesity Source: World Psychiatry, Journal of the World Psychiatric Association, Vol 10, Feb. 2011, p. 51-77, Hert et al.
The Numbers Cardiovascular Disease The rates of CVD in individuals with Schizophrenia and BPD is 2 to 3 times greater, especially for younger individuals Source: World Psychiatry, Journal of the World Psychiatric Association, Vol 10, Feb. 2011, p. 51-77, Hert et al.
The Numbers Cardiovascular Disease Individuals with MDD, BPD and Schizophrenia have higher risk for death due to CVD and for the population with SMI it is the most common cause of death Source: World Psychiatry, Journal of the World Psychiatric Association, Vol 10, Feb. 2011, p. 51-77, Hert et al.
The Numbers Cerebrovascular Disease The risk is nearly 3 times higher in individuals with schizophrenia Source: World Psychiatry, Journal of the World Psychiatric Association, Vol 10, Feb. 2011, p. 51-77, Hert et al.
SOMEONE YOU KNOW Has been diagnosed with: Depression/Bipolar Illness Anxiety Schizophrenia Attention Deficit Disorder (Not just for kids) Substance Use Disorder Intellectual/Developmental Disability
Needs Screen/Evaluation/Assessment Treatment (individual and family) Coordinated care with consideration of community/school/work impacts Coordination with primary care physician due to impacts on physical health and wellbeing
Evaluation Screen SUD Trauma Psychiatric symptoms Developmental Disabilities Physical Health Conditions
Treatment Referral for treatment Don t forget natural and community support Individual and Family Education component
Coordination Coordinated treatment of: PH condition BH condition Co-occurring SUD Intellectual and Developmental Disabilities
Modalities Pharmacologic BH Therapies Targeted PH treatments Smoking cessation, weight loss/healthy lifestyle promotion, regular screenings and monitoring of HbA1C, BP, Cholesterol and Triglyceride screenings
Modalities Monitoring for medication effects such as metabolic syndrome for those on certain drugs
Modalities BH Therapies that are Best Practice (cont) WRAP (Wellness and Recovery Action Plan) DBT for individuals with self harming behaviors Various group therapies such as Integrated Group therapy, Therapeutic Community Treatment Peers (individuals with experience with the condition who can help the person navigate)
Modalities BH Therapies that are Best Practice CBT for depression MST for severely conduct disordered youth ACTT designed to support multiple domains for individuals with Schizophrenia via a team