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United States: Integrated Care for People with Mental Illness

Since 1998, the University of Illinois at Chicago College of Nursing has worked with Thresholds Psychiatric Rehabilitation Centers, in metropolitan Chicago and its suburbs to provide integrated primary care to mentally ill clients. The University of Illinois Integrated Health Care (IHC) Program is a local project that locates primary care clinics in existing Thresholds’ centres. As a not-for-profit nurse-managed centre, the IHC Program is a vehicle through which faculty, family-nurse practitioners and mental health clinical nurse specialists provide integrated physical and mental health care for people who have serious mental illnesses and are either at risk, or also have, co-morbid chronic physical disease.

The IHC Program is staffed by seven family nurse practitioners, two psychiatric nurse specialists, two registered nurses, two medical technologists, two nurses (in management posts), and undergraduate and graduate students of nursing and other health professions. All the master’s prepared nurses are faculty in the College of Nursing and preceptors of the students rotating through IHC clinics. In 2007, 934 unduplicated members (257 new to the IHC clinics and 677 returning) were seen at IHC clinics, and 4,222 clinic visits were made – an average of 4.5 visits per member.

The IHC Program is funded by third-party payers, grants, private donations and the College of Nursing; volunteers donate time. Since 2007 it has qualifi ed for enhanced reimbursement from Medicare and Medicaid, as well as other benefits. It has also received a five-year Health Resources and Services Administration grant to extend its services to underserved clients with severe mental illness who are unable or unwilling to leave home to seek primary and chronic-care management. The 2008 combined annual budget for the IHC Program is US$ 1,195,100.

The IHC Program has developed a robust database to support outcome monitoring, analysis and evaluation. Data analysis has led to modifications to care-delivery methods, education of members, and quality monitoring. All IHC advance practice nurses participate in peer review, work closely with Thresholds case managers and psychiatrists, and refer members to medical and other specialists in the community as needed. Outcome data demonstrate a strong uptake of the service and improvements in a range of physiological parameters.

Explore the entire Compendium of Primary Care Case Studies (2009) published by the World Health Organization.