Medical Care of People with Severe Mental Illness

Current literature indicates that people with severe mental illness have higher mortality rates than the general population, with the most common cause being increased rates of cardiovascular disease. Unfortunately, despite national metabolic screening guidelines, people taking antipsychotic medications are unlikely to receive metabolic screening, which likely contributes to excess cardiovascular mortality. Given the significant disparities in health care received by people with severe mental illness, any effort to improve the quality of medical care of this highly vulnerable population are extremely important. Improving metabolic screening rates in people with severe mental illness will increase early detection and treatment, thereby reducing premature mortality rates. Below are some of the studies underway in PReMIUM to reduce this health care disparity.

CRANIUM: Creating a Culture change in community mental health clinics through having a Registry and reminders, Advice to get medical screening, peer Navigators, identification of Illness, Umbrella of services, and initiating Medications
PI: Christina Mangurian
Collaborators: Dean Schillinger, Grace Niu, Eric Vittinghoff, James Dilley, Liz Goldman, Fumi Mitsuishi, Dave Fariello, Marilyn Thomas, Stephen Chan
Health Delivery System Partner: San Francisco Health Network-Behavioral Health

The goal of the CRANIUM project is to develop and implement a practice-based intervention to improve metabolic screening in diverse populations with severe mental illness. The primary focus of CRANIUM is to create a culture shift where psychiatrists are encouraged to take a more active role in preliminary treatment of metabolic abnormalities in community mental health clinics. The results from this project will transform the way medical care is provided.

The CRANIUM study is funded by an NIH Career Development Award (K23MH093689), an NIH Core Grant (P30DK092924) and the UCSF Hellman Fellows Award for Early-Career Faculty.

CalMEND Data: Evaluating Integration of Care Across California
PI: Christina Mangurian
Collaborators: Dean Schillinger, Grace Niu, Eric Vittinghoff, James Dilley, Elena Fuentes-Afflick, Penny Knapp, Evan Trager, Melanie Thomas, Walker Keenan, Jennifer Creasman, Francine Cournos
Health Delivery System Partner: California Department of Healthcare Services

The goal of California’s CalMEND project was to encourage integration of care throughout the state. Dr. Mangurian partnered with Dr. Penny Knapp—the Medical Director of the California Department of Public Health—to evaluate this project. Dr. Mangurian has a cohort of close to 60,000 people with severe mental illness taking antipsychotic medications and receiving care in community mental health settings. She is examining health care received by this population, specifically diabetes screening, HIV testing, Hepatitis C testing, pap screening, mammogram screening, and health care utilization. The results from this project will help identify gaps in care for this vulnerable population.

The CalMEND Data study is funded by an NIH Career Development Award (K23MH093689) and the UCSF Hellman Fellows Award for Early-Career Faculty.

DISCO: Diabetes Screening and Care Wraparound Study
PI: Christina Mangurian
Collaborators: Julie Schmittdiel, Dean Schillinger, Eric Vittinghoff, Susan Essock, John Newcomer, Sara Adams, Constance Weisner
Health Delivery System Partner: Kaiser Permanente Northern California

The DISCO project aims to examine diabetes screening and care received by a racially and ethnically diverse, insured population with severe mental illness served within an integrated health care delivery system. Because of the integrated electronic health record, this is the largest study to be able to examine diabetes screening, prevalence, and management among a diverse population with severe mental illness. The goal of the DISCO project is to identify patient-, provider-, and system-level targets for future interventions to close this large diabetes screening and care gap among racial/ethnic minorities with severe mental illness.

The DISCO study is funded by the NIH National Institute of Diabetes and Digestive and Kidney Diseases (R03 DK101857).

HEALTH: Healthy Eating Among Latinos Treated in the Heights
PI: Christina Mangurian
Collaborators: Francine Cournos, Susan Essock, John Newcomer
Health Delivery System Partner: New York Psychiatric Institute's Washington Heights Community Service

The HEALTH project, led by Dr. Christina Mangurian, was a series of classes designed to teach healthy eating habits and weight-loss tips to Latinos with severe mental illness concerned about their weight. Over 14 weeks, 20 weight loss groups were held. During each week, participants engaged in weight-related tasks such as keeping workbooks, food charts, and pedometer counts. At each session, participants would complete a weigh-in and update a weight-loss goal.

Please see our Resources page to download materials from the HEALTH project!

The HEALTH Study was funded by a NARSAD Young Investigator Award and the APA/Lilly Schizophrenia Research Fellowship.