Arizonans with serious mental illness die on average three decades earlier than the regular population — a troubling statistic a new Tucson clinic is aiming to change.
Banner Health’s Whole Health Clinic, which opened Feb. 2, is where people with mental illness can receive behavioral and primary health care in one place. It occupies 19,000 square feet on the second floor of a Banner building at 535 N. Wilmot Road near East Fifth Street.
A message handwritten on a whiteboard inside a room intended for socializing reflects the clinics’ philosophy: “If you treat people like they make a difference, they will.”
Putting behavioral health providers in the same building as primary care doctors is not new, but Banner’s Whole Health Clinic is different for several reasons, including an integrated “team approach” to its patients, clinic leaders say.
Therapy and flu shots
“An individual can come here and receive psychiatric assessment, come for therapy and groups, as well as come when they have a sore throat or need an immunization,” clinic director Patricia Harrison-Monroe said.
The spacious new clinic is staffed by psychiatrists, clinical psychologists, therapists, family physicians, case managers, nursing staff, peer-support specialists and enrollment specialists who can help people sign up for health insurance.
Each morning members of the team hold a “huddle” to discuss patients and exchange ideas on their treatment plans. Every member of the team is considered an equal.
“Patients with severe mental illness have notoriously shortchanged their physical health care,” said Dr. Ole J. Thienhaus, chairman of the department of psychiatry at the University of Arizona. The UA is a partner in the clinic.
“They are much more prone to developing obstructive pulmonary disease because they are smoking a lot. They are at high risk of developing Type 2 diabetes not only because of diet but because of the medications they are on that affect their metabolism.”
Those living with serious mental illness also are often living on low incomes, lack adequate information about healthful food choices and have historically lacked access to regular medical care, Whole Health Clinic leaders say.
And many Pima County residents with severe mental illness don’t have a primary care provider, Harrison-Monroe said.
“In part that has to do with lack of resources and knowledge of resources, but also on the provider side there is a lot of stigma. … It’s not necessarily a welcoming system,” she said.
Whole-health trend
Integrated or whole-health care is an increasingly popular model used by regional behavioral health authorities (RBHAs) throughout Arizona.
In Pima County, the RHBA is Cenpatico Integrated Healthcare, which oversees the public system’s mental health care for adults and children. Cenpatico officials did not respond to the Star’s questions about whole health by the paper’s deadline Friday.
Though it’s too early to know whether Banner’s Whole Health Clinic is working, the concept makes sense, says Clarke Romans, executive director of the Southern Arizona chapter of the National Alliance on Mental Illness.
Treating behavioral health problems separately from other problems is having a detrimental effect on patients, he said. Mental illness is not itself causing early death, but co-morbidities such as smoking, lack of exercise and weight gain are.
“The notion that doctors should be in teams and treat across a continuum is good,” he said. “At least in theory I believe it must be better.”
When someone with a serious mental illness has a physical complaint and ends up in an urgent care or emergency department, the mental health issues can end up becoming the focus, Harrison-Monroe said.
“When they present, the first thought is, ‘Oh, psych patient’ as opposed to a regular citizen coming in with a medical complaint. And that really deters people,” Harrison-Monroe said.
The Whole Health Clinic provides a treatment environment that is open and welcoming and not afraid of the person in front of them, she said.
Early psychosis intervention
Not everything about the Whole Health Clinic is brand-new. An existing and nationally recognized program called the Early Psychosis Intervention Center has been relocated there. The program is known as EPICenter and the UA Department of Psychiatry has operated it since 2010 at Banner–University Medical Center South. About 125 people have gone through the program to date.
The approximate age range of patients in EPICenter is 15 to 35 — an age range when the vast majority of severe mental illness starts. The patients are often in early stages of schizophrenia and other serious mental illnesses. The program has 35 to 40 active patients right now and there is a waiting list.
The theory of the program is that the earlier the intervention with someone who has had a psychotic break, the better the outcome. And many can avoid the path of permanent disability, Thienhaus and Harrison-Monroe say.
The interventions include family groups, a computer-based problem-solving program with a therapist, and specialized cognitive-behavioral therapy for psychosis that focuses on increasing coping skills and understanding the symptoms.
“It really should be the treatment of choice, rather than just giving them medications and assuming they are going to be disabled and chronic for the rest of their lives,” Harrison-Monroe said.
If someone has voices that are telling them to hurt other people, one coping mechanism might be social isolation, for example.
“We don’t say that’s wrong. But we give other ways to have better control over scary thoughts,” Harrison-Monroe said.
“We don’t dismiss what patients have tried up until now because we really think people really are doing their best. We just give them more skills.”
Social isolation
A key focus at the Whole Health Clinic is addressing social isolation for all its patients by giving them the tools to empower themselves.
Peer counselors who have struggled with mental illnesses themselves are there for support. The clinic also offers a place where patients can spend time and socialize with one another.
The traditional system can leave people with mental illness in a situation where they are being told what to do, Thienhaus said. The aim of the whole-health model is letting the patient take control of their health, ideally preventing them from being at the mercy of another entity such as the criminal justice system.
In its first year, the clinic expects to see between 350 and 400 patients. By the end of its third year that volume is expected to reach 1,500, Harrison-Monroe said.
Banner-University Medical Center South, 2800 E. Ajo Way, has 81 inpatient psychiatric beds that are typically running a high census. Those patients are expected to be a major referral source for the Whole Health Clinic, as is the Crisis Response Center, also at Banner’s south campus.
Except for the EPICenter, the Whole Health Clinic is not currently seeing patients under the age of 18, though that could be part of its future.
If patients are empowered, it can go a long way to removing the stigma that is putting up barriers to a fulfilling life, Romans said.
The unemployment rate for people with serious mental illness does not need to be high, but it is, he said.
“So many people come into our building and it breaks your heart how they are living, struggling,” Romans said. “I’d really like to see some momentum with whole health care to make it work.”
