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A whole-person approach: a mental healthcare provider offers on-site primary care and wellness services.

Article Excerpt
People with serious mental illnesses often suffer with chronic, many times life-threatening, physical health conditions. They can have difficulty accessing primary care services or be treated by general healthcare providers who do not fully understand their needs. To ensure people with mental illnesses also have their physical health addressed, Skyland Trail, an Atlanta-based residential and day mental health treatment center specializing in depression, schizophrenia, and bipolar disorder, opened an on-site, full-time primary care clinic--one of likely only a few nonprofit community-based mental health centers that have done so.

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Recognizing the need

The National Association of State Mental Health Program Directors reports that adults with serious mental illness treated in public systems have a life expectancy about 25 years shorter than average Americans. Additionally, according to the National Institute of Mental Health's CATIE study, patients with schizophrenia have an inherent predisposition to metabolic syndrome, which is worsened by their often sedentary lifestyles, poor dietary habits, and medications' side effects. Subsequently, people with schizophrenia experience a higher risk of morbidity and mortality than the general population.

Despite these disturbing data, a divide between primary and mental healthcare persists, a gap that Ray Kotwicki, MD, MPH, Skyland Trail's medical director, says may partially be a consequence of fundamental biases by both primary and mental healthcare professionals.

"On the mental health side, we tend to focus on our own area of expertise in a very systematic approach, and the same is true for primary care clinicians," Dr. Kotwicki explains. "Oftentimes patients' mental concerns are so complex that we just don't have the resources to cover soup to nuts.

"Additionally, when certain healthcare providers see a serious mental illness, their biases may indirectly cause them not to ask thorough questions," he continues. "For instance, if a physician sees a patient who is schizophrenic and complaining of chest pains, many times be assumes that patient is...

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