Issue 1, Number 3 - Fall/Winter 2011

Buckelew Programs model ‘whole person’
health care

By Steven Ramsland, EdD

When it comes to national statistics about people with mental health and substance use disorders, the numbers are admittedly daunting. Nearly one-third of adults and one-fifth of children in the United States had a diagnosable substance use or mental health problem in the past year. Recent studies show that people with serious mental illness die at least 25 years sooner than the general population from common medical conditions such as cardiovascular and pulmonary diseases. Their health care costs are also substantially higher, primarily due to preventable emergency department visits, hospital admissions, and readmissions.

This is because people with behavioral health conditions are at higher risk than others for expensive chronic medical conditions. According to federal data, 34 million American adults—17 percent of the adult population—had both mental and medical conditions within a 12-month period. Those with serious mental illness frequently suffer from co-occurring diabetes, obesity, high blood cholesterol, or coronary heart disease— conditions that are collectively referred to as “metabolic syndrome”—resulting in higher medical costs, reduced quality of life, and premature mortality.

But there is some good news in the North Bay Area. Annual rehospitalization rates for one behavioral health organization in Marin, Sonoma, and Napa counties average 10 percent compared to a statewide average of 47.8 percent. At least one reason is Buckelew Programs, a safety net organization that provides behavioral health services including residential detoxification, outpatient treatment, respite, case management, housing, and employment for insured and uninsured behavioral health clients. By addressing chronic medical conditions and certain social determinants of poor health such as poverty, unemployment, and homelessness, Buckelew has had remarkable success helping clients reduce medical hospitalizations while achieving and sustaining greater mental and economic health. Buckelew’s housing programs provide homes and support services to some 600 individuals, while the organization’s employment programs help 300 people per year obtain or maintain well-paying jobs.

What is Buckelew Programs?

Buckelew Programs is a non-profit behavioral health organization with a reputation for successfully helping people with mental health and substance use conditions avoid unnecessary psychiatric and medical hospitalizations, achieve recovery, and maintain wellness in their communities. Based on a “whole person” philosophy, Buckelew’s care managers not only provide services to address each client’s behavioral health and economic situation, they also coordinate with primary medical caregivers to address the multiple, interrelated, and chronic health problems their clients often face.

Buckelew provides a range of services aimed at reducing smoking and substance abuse, increasing exercise, improving nutrition, connecting clients with primary and specialty medical care, and helping them navigate the gaps between behavioral and medical care.

Buckelew helps clients plan for success

Buckelew staff work with clients to create an Integrated Care Plan (treatment plan) and a personal Wellness Recovery Action Plan (WRAP) that addresses personal health management strategies.

WRAP complements the treatment plan to support recovery and long-term stability and help clients identify what makes them healthier. They learn tools for managing difficult feelings and maintaining wellness. A common component of WRAP is smoking cessation. According to the Centers for Disease Control, 44 percent of all cigarettes sold in the United States are purchased by people with serious mental illnesses, who smoke at a rate twice that of the general population. As a known killer, smoking is also an expensive habit that people on Medi-Cal cannot afford to maintain. Currently, 30 percent of Buckelew clients are taking advantage of free smoking cessation education and support, including access to smoking cessation patches.

One such client, Jane, joined Buckelew’s Smoke Busters program in 2004 after more than 30 years of heavy smoking and numerous attempts to quit. In her mid fifties, Jane suffers from serious mental illness and emphysema. In her WRAP plan, Jane set her goal to “be able to breathe and to not cough up blood or fracture a rib from coughing so hard.” Typical smoking cessation programs were simply never enough to help her quit. She required more frequent, comprehensive, long-term support adapted to her particular situation. Today, Jane has maintained her smoke-free status for more than a year, reduced her emphysema symptoms, and improved her overall health.

New wellness programs make a difference

Another Buckelew wellness initiative is a metabolic health pilot study operated in partnership with the Marin County Community Mental Health Services Medication Clinic. A group of 20 high-risk clients are involved in the pilot, which includes increased exercise and improved nutrition.

“I’ve learned a lot, like changing recipes to cut down on fat and using more spices to make food healthier,” said John, another Buckelew client who lost more than 20 pounds in six months. “I’ve also learned to read labels to see what’s really in the package. You can’t eat too much. You start with a small portion and maybe that is enough. Then, you really have to taste the food and take your time to feel if you’re full. Also, I walk more and am doing crunches every day to build my stomach muscles to help with my back pain.”

Buckelew also introduced another prevention program this year, InSHAPE, for 16- to 25-year-old clients. Studied for its effectiveness by the Dartmouth School of Medicine Psychiatric Research Center, the program seeks to improve physical health and quality of life, and reduce the risk of preventable diseases for people with mental illness. Each InSHAPE participant works with a trained health mentor to create a Self-Health Action Plan for Empowerment (SHAPE) that includes physical activity, healthy eating goals, and attention to medical needs. The mentor helps each participant implement an individualized SHAPE plan by encouraging participation in a variety of activities and even attending with the participant until they are comfortable enough to continue going alone. Every 12 weeks, participants attend a celebration where they are recognized for their efforts.

Coming Soon: Health Homes

At the moment, clients are referred to Buckelew by county Mental Health Services departments, the California Department of Rehabilitation, third-party insurers, and word of mouth. The organization’s primary source of financial support is government funding, such as Medi-Cal, and supplemented by client fees and private donations.

As federal healthcare reform unfolds over the next few years, expect to see a more integrated approach to the delivery of healthcare services by combining primary care, dental, and behavioral health services under one umbrella called Health Homes (also known as Medical Homes). As envisioned by the national Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA), Health Homes will become a key component of the healthcare system in the future. These will provide both physical health services and long-term community behavioral health services through organizations such as Buckelew Programs that are so necessary for achieving recovery and maintaining wellness.

Through new payment arrangements, Health Homes will align clinical and financial incentives to meet health reform’s triple aim of higher quality, improved patient health, and reduced costs. Buckelew is already part of this transition by continuing to deliver services that address the social determinants of health, prevent hospitalization, and promote wellness and recovery, while also strengthening partnerships and integration of care with primary health providers.

To learn more about Buckelew Programs, visit www.buckelew.org or call 415.457.6966 in Marin, 707.571.5581 in Sonoma, and 707.253.2655 in Napa.

About the author: Steven Ramsland, EdD, is CEO of Buckelew Programs. Over the past 30 years, Dr. Ramsland has held executive positions in several for-profit and non-profit organizations. He has served on state and national public policy boards, and has developed new social enterprises and other services benefitting ental health consumers, their families, and the environment.