Mental health services widened

As President Bush continues to push plans to improve access to mental health services nationwide, several hospitals in Boston's northern suburbs are taking steps to enhance their care of people with behavioral or mental health needs.

In recent months, hospitals from Lynn to Newburyport have invested tens of thousands of dollars in programs that seek to improve medical treatment for those who suffer from problems ranging from depression and anxiety to psychotic disorders such as schizophrenia.

Several area hospitals -- including Anna Jaques Hospital in Newburyport, Salem Hospital, and Union Hospital in Lynn -- have behavioral health experts on-call 24 hours a day and carefully monitor patient records in hopes of detecting early any pattern of mental illness. In addition to those efforts, Melrose-Wakefield Hospital and behavioral health professionals in Beverly integrate acute and psychiatric care.

The holistic approach helps curb costly emergency room visits and shortens the length of time patients remain in the hospital, according to health officials at Hallmark Health, owner of Melrose-Wakefield Hospital, and Health and Education Services Inc. of Beverly, which provides behavioral health services to patients of the Northeast Health System. The health care system operates Addison Gilbert Hospital in Gloucester, Beverly Hospital, the Hunt Center in Danvers, and BayRidge Hospital in Lynn.

"An elderly patient who is a diabetic and suffers from depression has several health care needs," said Janet Lensing, systems director of behavioral health for Hallmark, the health care system that includes Lawrence Memorial Hospital in Medford and the Malden Medical Center, as well as Hallmark Health VNA Inc., which provides home health care services to about 650 patients in Malden and 23 other communities north of Boston.

"Traditional medical units could treat the diabetes, but would not be able to treat the depression, and a traditional psychiatric unit would be able to treat the depression, but would not address the diabetes," Lensing said. "By integrating our services, we are able to treat both simultaneously; it cuts down on the amount of time a patient spends in the hospital and results in a better outcome."

Individuals who are mentally ill are three times more likely than the general population in Massachusetts to die of suicide, homicide, or accidental injury, according to the state Department of Mental Health. The mentally ill also have higher rates of cardiovascular and respiratory diseases than the general population, and often receive inadequate physical health care.

In an effort to improve those statistics and better the lives of residents who grapple with behavioral health issues, Health and Education Services last month launched a program that integrates acute care and mental health services by providing primary care for the seriously and persistently mentally ill.

"Because seriously and persistently mentally ill patients often do not receive the routine primary care they need, illness, and mortality rates for this group are typically higher than that of the general population," noted Judith Boardman, vice president for quality management at Health and Education Services. "By placing a qualified health care professional in the behavioral health setting, we hope to improve their access to care and create a model of integration that is sustainable and can be replicated throughout the entire Northeast Health System."

Those who suffer from mental illness often have difficulty accessing appropriate medical care, and many have no health insurance or primary care doctor, according to health advocates. As a result, they often end up seeking emergency care for minor injuries and illnesses.

Health and Education Services offers acute care to mentally ill patients one day each week at its Salem clinic. So far, about a dozen patients are enrolled in the program. Boardman would like to expand the program to 150 patients and this month secured a $20,000 grant from Blue Cross-Blue Shield of Massachusetts to aid the effort.

"The nurse is very thorough," said Ken Gilbert, 54, who was among the program's first patients. Gilbert has a primary care physician but prefers to visit the Salem clinic because it's within walking distance of his house. He suffers from depression and high blood pressure, which must be closely monitored.

Nurse practitioner Kathleen Belmonte ''takes the time to answer all of my questions," Gilbert said. ''Right now, she's helping me get my diet under control by making a list of the foods I can eat, and the ones I need to avoid."

Boardman said the human services agency decided to provide primary care to mentally ill patients at its Federal Street clinic after completing a six-month study last year.

The study found that mentally ill patients used the emergency departments at Beverly Hospital and Addison Gilbert six times more frequently than the general population.

The study also found that when mentally ill patients were given access to primary care, they were able to better manage chronic diseases, such as diabetes and hypertension.

As a result, they visited the emergency room less frequently. During the study, emergency department visits fell 42 percent among patients who had access to the nurse practitioner at the Salem clinic, Boardman said.

The goals of the area programs are in line with Bush's efforts to improve mental health services across the country.

The president's Freedom Commission on Mental Health, established in April 2002, strives to reduce the stigma attached to mental illness, improve access to mental health services, eliminate disparities in mental health services, and provide better coordination between mental health services and primary health care, according to the commission's mission statement.

The goal of the commission is to ensure "everyone with a mental illness at any stage of life has access to effective treatment and supports -- essentials for living, working, learning, and participating fully in the community."