For people struggling with homelessness, addiction or severe mental illness, visiting a primary care doctor may be the last thing on their mind. But community mental health providers, including St. Louis-based Places for People, are starting to offer primary care services to their clients in the hopes of reducing rates of premature death among people with mental illness.
An internal survey at Places for People showed that many of the organization's clients suffered from physical health conditions like hypertension, diabetes and obesity in addition to the psychological conditions for which they were already being treated. Others reported experiencing side effects of psychiatric medications. But nearly a third had not seen a primary care physician in the past year.
David Whitt is a case in point of the issue.
On Monday, 47-year-old Whitt patiently waited while a nurse took his temperature, blood pressure and other measurements. He said caseworkers at Places for People had referred him to the new doctor’s office in the center’s basement. He said he hadn’t seen a doctor since he visited an emergency room a few years ago, after being hit on the head with a pipe.
“Depression, stress, anxiety; it’s part of living out here on the streets,” Whitt said.
Whitt said he hasn’t sought care at hospitals or other providers because he doesn’t have insurance or the money to afford a co-pay.
Mental health providers say transportation difficulties, scheduling and a reluctance to seek care from unfamiliar doctors are all reasons their clients often don’t get regular check-ups.
“What we know is that toxic stress and trauma both contribute to physical health conditions,” said Joe Yancey, the executive director of Places for People.
Yancey added that coping mechanisms, such as smoking or eating unhealthy food, also tend to work against the physical health of his clients, However, the healthcare system nearly always separates the doctors who treat the mind and body.
“We’re looking at the entire person, and we have a responsibility for the overall health and well-being of that individual,” said Yancey. “That’s why it was so critically important.”
Most disturbing to providers at Places for People was the finding that, between 2011 and 2013, the average age of death for their clients was more than 20 years earlier than the average life expectancy in the general population. This finding lined up with a recent study from the National Association of State Mental Health Program Directors, which estimated that people with serious and persistent mental illness would die 25 years earlier than members of the general population, on average.
“It was a huge slap in the face to me, and I think it was to many in our healthcare system,” said Yancey. “We were aware of these things, but actually being able to operationalize them required resources and funding to provide that level of care.”
The new, two-room clinic is open twice a week, four hours each Monday and Wednesday. Coordinators estimate it will serve about 150 patients in the first two years. It’s staffed by a nurse and Dr. Amy Hilmer, a doctor of internal medicine from St. Louis-based Family Care Health Centers.
“People who have an underlying mental illness have a higher risk of having complications because of metabolic syndrome, diabetes and hypertension,” Hilmer said. “They really are patients who are in need of having a primary care doctor that follows them closely.”
The new clinic is an extension of a program begun last year in which mental health professionals from Places for People go to Family Care Health Centers to see clients. The exchange is funded by a $225,000 grant from the Missouri Foundation for Health.
The St. Louis area’s first mental health provider to use the concept was Ballwin-based ADAPT of Missouri in 2010. They now provide primary care services for about 170 of their clients.
“It’s more convenient, having everyone on the same page. We have to start looking at people holistically,” said Cindy McDannold, who directs the Healthcare Home program there.
According to McDannold, primary care providers without experience treating these clients may assume symptoms of a chronic physical condition, such as diabetes, are actually due to their mental illness.
“Our clients are not getting the care they need and it’s not acceptable,” McDannold said.
Crider Health Centers have also begun to co-locate primary care services in their Union and Wentzville locations.
The Missouri Foundation for Health is a donor to St. Louis Public Radio.
