Posted on February 28, 2011
Kenneth J. Dudek
President, Fountain House
New York State is completely revamping its Medicaid system, especially for people with serious mental illness. Data provided by the State Office of Mental Health demonstrates that people with serious mental illness incur a large proportion of Medicaid hospital costs for psychiatric reasons, but an even larger proportion of hospital costs for reasons of physical health. More shocking than that, despite this heavy use of hospitals and costly medical services, people with serious mental illness die twenty-five years earlier than the average person.
A new solution to this tragedy is on the horizon under the name “health homes.” In a health home, people would have one doctor or group of doctors overseeing their complete care – both mental and physical health – and a professional coordinator who would follow patients, no matter where they go for help.
To my mind, the crucial question is this: will these health homes be abstract concepts in a computer system, or will they be real places where patients go to for this coordinated care?
Health and mental health planners often design systems at a very high level, on a very large scale, usually quite removed from the day-to-day lives of the people who need help. Frequently, they devise systems that include many different services, all in separate locations; they implement a computer system to track it all and then call it comprehensive. However, to the customers or patients who must go from place to place to get what they need, the experience is fragmented, difficult to navigate, and alienating.
The best way to reach this group effectively is to develop one-stop locations with very good teams who reach out and bring people in for help. We have been designing such a place for the last twenty years. At our Sidney R. Baer Center, psychiatrists and general practitioners are attuned to the special health needs of people with serious mental illness. Combined with the community support of Fountain House, a few blocks away, we offer a truly comprehensive health home. Real health homes must be real places.