Integrated Care for Older Adults with Serious Mental Illness and Medical Comorbidity

Abstract

The excess risk of early mortality, medical comorbidity, early institutionalization, and high costs among older adults with serious mental illness necessitates development and dissemination of effective and sustainable integrated care models that simultaneously address mental and physical health needs. This overview highlights current, evidence-based integrated care models, which predominantly adopt the following approaches: (1) psychosocial skills training, (2) integrated illness self-management, and (3) collaborative care and behavioral health homes. Finally, innovative models that build on these approaches by incorporating novel uses of telehealth, mobile health technology and peer support, and strategies from developing economies are discussed.

Doctor-Diagnosed Arthritis and Self-Reported Physical Health Function Among Middle-Aged and Older Adults With Serious Mental Illness

“…Moreover, an SMI diagnosis might add other treatment barriers and complicate arthritis-related physical health and psychosocial risks and implications (Bayliss et al, 2003). For instance, age-related decline in health function among older adults with SMI is further exacerbated by SMI-specific deficiencies, such as avolition, functional impairment in self-care and health self-management skills, adverse effects from long-term psychotropic medication use, high health care costs, and inadequate health care (Bartels et al, 2018). New treatment programs, then, might also need to be developed to emphasize targets and active components of psychotherapeutic or behavioral interventions that are tailored and might be useful for aging adults with SMI.…”

A blueprint for integrated mental health care

“…Some have gone so far as to build behavioral health homes for SMI patients, a form of reverse integration where components of medical care are embedded into a unit focused on serious mental health needs. [5][6][7] Despite these advances in our conceptual knowledge, given the numerous design options and management decisions necessary to create functioning integrated mental health services, the implementation handbook remains comparatively thin. 8,9 Understanding this broader context and current trends toward integrated mental health care delivery may be the easiest part.…”

“…Clearly the more specialized services required for moderate to severe mental illness go well beyond what the typical integrated primary setting can offer. Some have gone so far as to build behavioral health homes for SMI patients, a form of reverse integration where components of medical care are embedded into a unit focused on serious mental health needs 5‐7 . Despite these advances in our conceptual knowledge, given the numerous design options and management decisions necessary to create functioning integrated mental health services, the implementation handbook remains comparatively thin 8,9…”

Peer Support in Coordination of Physical Health and Mental Health Services for People With Lived Experience of a Serious Mental Illness

“…Sharing similar lived experiences can improve quality of life, reduce loneliness, enhance symptom control, and increase engagement in treatment for individuals with SMI (9-11). Peer support specialists can also encourage health behavior change in people with SMI (12)(13)(14) and can be valuable in the coordination of care transitions from inpatient units to a community setting (10,15). Peer support specialists have been shown to help individuals with SMI to improve their self-management skills and to improve access to primary care (4).…”