Mental illness is a serious and often overlooked issue for the Medicare population (1). In the United States, approximately 43.8 million adults experience mental illness in a given year (1). Twenty-six percent of these adults are Medicare beneficiaries and note cognitive and/or mood disorders (2). Considering the increased risks of hospital readmission and care plan noncompliance for this patient population, Chronic Care Management should optimize integrated, cost-effective care for patients affected by mental disorders and cognitive impairment. General improvement in various aspects of care (e.g., daily mood, caregiver education, and support access) should result in better outcomes for patients participating in Chronic Care Management. Causes of mental health impairments should be addressed and supporting resources should be provided to Chronic Care Management recipients to promote independence.
Causes and Risk Factors for Mental Health
There are numerous psychological factors that may contribute to patients’ mental illnesses. A loss of a loved one, trauma from any form of abuse, or experience of neglect are just some examples of concerns that may be voiced by a Chronic Care Management patient. Coordinators should be attentive and communicate with their patients in a compassionate manner. CCM patients should be assessed for triggers related to their mental illness, such as, the following:
- Dysfunctional family life
- Feelings of inadequacy
- Low self-esteem
- Substance abuse
- Financial strain
Medicare beneficiaries with severe mental illness have complex health needs and often utilize high volumes of medical services. Medicare spends five times more on beneficiaries with severe mental illness and substance abuse disorder than on similar beneficiaries, without these diagnoses (1). Together, Chronic Care Management patients and their coordinators should work towards better management of mental health illnesses resulting in improved compliance and lower stress levels.
Chronic Care Management Interventions for Mental Health
CCM coordinators should use their clinical experience and knowledge of the local area to locate resources for Chronic Care Management patients with mental health conditions. According to the National Alliance on Mental Illness, one in every twenty adults is living with a serious mental health condition such as schizophrenia, bipolar disorder or long-term recurring major depression (3). Some Chronic Care Management patients also have depression associated with chronic conditions (e.g. diabetes, multiple sclerosis, and Parkinson’s disease) as a result of hardships from impaired mobility and loss of independence. CCM patients may voice concerns with medication costs, shelter expenses, assistive device access, and/or clothing needs. Anxiety and panic disorders may be common among Chronic Care Management patients with elevated stress from financial strains. Chronic Care Management patients may receive assistance by way of the following:
- Local support groups
- Medication management systems
- Food pantries
- Medication discounts
- Food supplement applications
- Utility assistance resources
- Therapy sessions with mental health providers
- Social involvement activities (e.g. volunteer opportunities, exercise classes)
- Routines for daily activity
Often, Chronic Care Management patients fall under certain categories as published by Mental Health America (4):
- 56% of American adults with a mental illness did not receive treatment
- 29% of adults struggle with a mental health problems annually
- 47% of adults in America report having a substance use or alcohol problem
- 84% of the time between first symptoms and first treatment is spent not recognizing the symptoms of mental illness
- 3% adults with a mental illness report they are not able to get the treatment they need
- 94% of adults with a disability were not able to see a doctor due to costs
To address these patients, CCM coordinators should support Chronic Care Management patients in overcoming challenges of widespread misunderstanding and symptoms related to mental health illnesses. Patients should have opportunities for personal growth and assistance as a result of participation in therapy sessions and support groups. CCM interventions such as implementing medication management systems, providing caregivers’ education, and establishing routine social interaction for CCM patients living with mental health illnesses should improve patients’ wellbeing and confidence.
- Center for Medicare Advocacy. [Online] [Cited: 10 25, 2016.] http://www.medicareadvocacy.org/medicare-and-mental-health/#_edn1.
- NAMI. National Alliance on Mental Illness. [Online] NAMI, 2016. [Cited: October 25, 2016.] http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers.
- National Alliance on Mental Health. NAMI. [Online] 2016. [Cited: October 28, 2016.] http://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition.
- Mental Health America. Mental Health America. [Online] 2016. [Cited: October 28, 2016.] http://www.mentalhealthamerica.net/issues/mental-health-america-adult-data.