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Dale Jarvis

Dale Jarvis and Associates

Am I Killing My Patients?

March 4, 2014 | Community Impact | Comments
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Am I killing my patients?

Burned into my brain are vivid memories of standing in the back of the room of the first large group presentation of the report, Morbidity and Mortality in People with Serious Mental Illness. (Memory jogger: “People with serious mental illness served by our public mental health systems die, on average, 25 years earlier than the general population.”)

At the end of the talk, I quickly stepped outside the meeting room so I could eavesdrop on the reactions. Aside from stunned faces, the most common reaction was, “Am I killing my patients by only treating their… (fill in the blank)?” — whether it’s major depression, bipolar disorder, schizophrenia, etc.

This is a supremely relevant question to those contemplating behavioral health centers of excellence (BHCOE).

Element 4: Comprehensive Care

“Provide or help me get the health care and services I need.” (Oregon Patient-Centered Primary Care Home Principles)

A BHCOE is known for offering a broad scope of mental health, substance use, and co-occurring disorder treatment services that are integrated with medical care and other services and supports. Each person or family has a single care plan that includes what is needed to move toward whole health, staffed by a multi-disciplinary care team — sometimes representing staff from multiple organizations — connected by an electronic care plan or client registry.

So, what do consumers of behavioral health services need to move toward whole health? Our friends at SAMHSA have identified nine categories of care that begin to answer this question.

  1. Healthcare home/physical health
  2. Prevention and wellness
  3. Engagement services
  4. Outpatient & medication services
  5. Community and recovery support (rehabilitative)
  6. Other supports (habilitative)
  7. Intensive support services
  8. Out-of-home residential services
  9. Acute intensive services

(Check out what’s listed in each category on the last page of the BHCOE concept paper.)

It’s important to note that there are very few organizations that can do it all. But, that doesn’t get you off the hook. I believe that for an organization to be seen as a great place to get care (part of the emerging BHCOE definition), no matter how small and specialized their offerings, it needs to have close working relationships with partner organizations to create a “health neighborhood” that fits the definition of Element 4.

Today’s questions…

Tell us what you think.

  • What was your reaction when you were first exposed to the morbidity and mortality report? Have we progressed since the report’s release in late 2006?
  • Am I asking too much of the nation’s network of community behavioral health organizations with Element 4?
  • Do you think it’s realistic to think that a small or very specialized behavioral health provider can ensure the provision of comprehensive care through health neighborhood partnerships or do we need to have only large, multiservice behavioral health centers?
  • What’s missing from my description of comprehensive care?

If you haven’t seen the behavioral health center of excellence draft concept paper, you can download it here. If you haven’t downloaded the behavioral health center of excellence study guide, get it here.


Bring your colleagues into this crowdsourcing project. Share posts and your view with them on Facebook and Twitter using the hashtag #WhatIsExcellence.


Read all blogs from this project here.