The Wellness and Recovery Medicine (WaRM) Center:
A Health Home for People with Serious Mental Illness
M Viron, G Levine, K Zioto
Kraft Center for Community Health; Massachusetts Mental Health Center; Harvard Medical School; Brigham and Women’s Hospital
PATIENT VIGNETTES
INTRODUCTION
Healthcare access barriers, fragmentation of services, and poor quality of care
have contributed to substandard health outcomes and early mortality in
people with serious mental illness (SMI).
Accessibility is Key
Massachusetts Mental Health Center
(MMHC) is a state-operated community
mental health center serving 1,100 people
with SMI, most of whom have at least one
chronic medical illness.
By transforming MMHC into a Health
Home with co-located and integrated
wellness and primary care services,
MMHC aims to improve the general health
and healthcare of people with SMI treated
in public sector settings.
METHODS
MMHC’s Wellness and Recovery Medicine (WaRM) Center provides
• Onsite primary care via partnership with Brigham and Women’s Hospital
• Two full-time primary care providers (internist and nurse
practitioner)
• Close collaboration with each patient’s mental health team
• Vision and dental services through local partnerships
• Center-wide wellness services
• General health screenings (“Health and Wellness Snapshot”)
• Data tracked via registry to identify medical needs
• Evidence-based interventions for tobacco cessation, diet, and
exercise
Mr. B is a 33 year-old man
with schizophrenia and
diabetes. He presented with
burning foot pain to the
WaRM Center’s primary care
clinic. He was routinely
skipping insulin doses, and
his HgbA1c was 14.9% (ideal
<7%). With the support of his
therapist, he attended the
primary care clinic weekly
and received diabetes
education. He was able to
change his diet and take his
insulin more consistently.
With increased personal
investment in his health care,
in two months he lowered his
A1c to 11%.
RESULTS
• Primary care clinic opened May 2013; serves 266 patients to date
• “Snapshot” screening data collected on 313 patients
• New wellness services introduced based on patient feedback
Health Screening is
Lifesaving
Ms. L is a 58 year-old woman
with schizophrenia and
recent blurry vision. She was
referred to the Eye Van for
routine vision screening.
Exam findings raised concern
for a tumor, and head
imaging revealed a mass
compressing her right optic
nerve. Over many months,
the WaRM Center worked
alongside Ms. L and her
mental health team to
engage her in medical care
and coordinate appointments
with multiple specialists.
CHALLENGES
•
•
•
•
•
Limited resources
Lack of interoperable and robust Electronic Health Records
No show rates (~40%)
Recruitment for and engagement in wellness services
Mental Health provider discomfort with medical issues
CONCLUSIONS
WaRM Center Clinical Services Flow Chart
The Health Home is a promising service delivery model for identifying and
addressing the physical health needs of people with SMI. Ongoing
monitoring of process of care metrics, health outcomes, and overall costs is
necessary to assess fully the efficacy and value of this model.
Chronic Medical
Illness Rates (n=313)
RESEARCH POSTER PRESENTATION DESIGN © 2012
www.PosterPresentations.com
Hypertension
46%
Chronic Pain
27%
Asthma
23%
Diabetes
20%
Bronchitis/COPD
16%
Heart Disease
8%
Hepatitis
7%
WaRM Center Yoga Class
FUTURE DIRECTIONS
• Peer wellness coaches and navigators
• Shared decision making, health education, self-management,
engagement/activation
• Integrated teaching and training models for mental health and primary care
trainees
• Smoking cessation care management program
• Nurse care managers
• Healthcare reform: MassHealth Health Homes, OneCare