Statewide Intervention to Reduce Early Mortality in Persons with Mental Illness

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DESCRIPTION (provided by applicant): In September 2009, New Hampshire's community mental health centers (CMHCs) will begin phased implementation of a groundbreaking, statewide, preventive intervention addressing critical risk factors associated with obesity-related cardio metabolic disorders in persons with serious mental illness (SMI). Such disorders contribute to a 20% shorter lifespan in that group. The intervention has two components: (1) A motivational health-promotion program (HP) consisting of "health mentoring" to assist persons with SMI in achieving improved physical activity, nutrition, smoking cessation, and self-efficacy, and (2) an academic detailing intervention (AD) that will target prescribers using Medicaid pharmacy claims to encourage decreased use of antipsychotic agents with high weight-gain propensity and decreased use of polypharmacy. NH's implementation of this two-component intervention (health promotion plus academic detailing, HP+AD) is based on promising outcome pilot data from two ongoing randomized, federally-funded effectiveness trials and recent approval by the NH State Office of Medicaid reimbursement for health promotion as an integrated mental health service. The evaluation of this natural experiment will use a two-component approach: 1) Person-level assessment of outcomes (Aim 1) for a sample of 120 consumers and their prescribers in 4 CMHCs. Outcomes to be compared between two early-implementation (HP+AD) CMHCs and two late- implementation (usual care) CMHCs include health behaviors, health indicators, psychiatric symptoms, self-efficacy, acute health service utilization, prescribing practices, program fidelity, and program costs. 2) System-level assessment of outcomes (Aim 2) associated with the HP+AD intervention as it is phased-in by the State's 10 CMHCs from health mentor record review and Medicaid claims, including consumer health behaviors, health indictors, acute health service utilization, prescribing practices, & program fidelity. This proposal responds to the NIMH's Strategic Plan priority to, in the words of Director Insel, "reduce premature mortality among persons with mental illness." This natural experiment presents an unprecedented, time-sensitive opportunity to evaluate the public-health impact of a statewide health promotion program for persons with SMI, which is a potential model for reducing early mortality for persons SMI served by state mental-health systems nationwide. 2. Relevance. People with serious mental illness die about 25 years younger on average than the general population, mostly because of obesity-related disorders such as heart disease and diabetes. New Hampshire is about to start a program encouraging exercise, healthier diet, and stopping smoking for people with serious mental illness (the first such program mostly covered by Medicaid) and to urge their doctors to prescribe fewer medications that cause weight gain and other life-shortening side effects. We propose to track the outcomes of this state program so that useful lessons can be drawn for similar, future efforts in other states.