In August 2016, we received a one-year planning grant from the Many Minds Collaborative to work with the UW School of Social Work and the King County Behavioral Health Research Division on a Partnership in Innovation in Mental Health (PIMH). The goal of this partnership is to improve the quality of care and health outcomes among individuals with serious mental illness who receive services in the King County public mental health system. Lydia Chwastiak, MD, MPH (Psychiatry), Maureen Marcenko, PhD (SW) and Debra Srebnik, PhD (King County) co-led the planning grant, and proposed a sustained partnership with two main activities: innovation initiatives with community partners and workforce development projects.

As its first Innovation Initiative, the Partnership proposed a two-year project to support King County Behavioral Health Agencies in the integration of physical health and behavioral health services, a practice change that is required as part of the Washington State Medicaid transformation.

People with serious mental illnesses have a life expectancy 10-20 years shorter than that of the general population. More than 60% of this premature mortality is caused by chronic medical conditions, and cardiovascular disease accounts for the vast majority. These health disparities are due to increased rates of poor health behaviors (smoking, lack of physical activity, diet that is high in fat), effects of antipsychotic medications, and poor quality of medical care for chronic medical conditions. While substantial research has developed and tested interventions to improve health behaviors and minimize adverse metabolic effects of antipsychotic medications, there have been few rigorous studies to evaluate the effectiveness of care models to improve the quality of medical care for patients with serious mental illness.

In August 2017, PIMH received a $1.1 million grant from Many Minds Collaborative to develop and implement a stepped approach to the management of chronic medical conditions in Behavioral Health agencies in King County. Dr. Chwastiak and her partners have been actively engaged with community members, Community Psychiatric Clinic (CPC) and Swedish Ballard Family Medicine, and Harborview Mental Health Services and Family Medicine Clinic. First year project aims are to 1) develop a chronic medical illness care model, customized to the local conditions of King County Behavioral Health agencies, that provides an acceptable and feasible collaborative care model for hypertension, hyperlipidemia and diabetes, that can be integrated into existing community mental health service delivery platforms; 2) identify the human resource mix to deliver these care models and develop implementation tools to facilitate scale up of the model; and 3) identify potential barriers and facilitators to implementation at scale.