July 21, 2004

Disease-Management Program in TX

The state of Texas has recently overhauled its mental health care system for the most severely mentally ill. By legislative order, all state-run clinics will implement a disease-management treatment model, beginning Sept. 1 2004.

Disease-management has been used successfully to treat chronic illnesses such as diabetes, but until now has not been implemented much in the treatment of psychiatric disorders. The model helps patients deal with daily life by "using scientifically proven methods and working with patients outside of clinics," says Janet Heimlich of NPR news, who covered the Texas story on a recent All Things Considered segment.

Sam Shore of the Texas Dept. of Mental Health and Mental Retardation, describes the services provided under a disease-management model. "We do things like build natural support systems, work with the families to be better able to help their family member cope with their mental illness, helping those individuals with mental illness get jobs, get stable housing that is safe and affordable."

Critics of the new mandate point out that only a minority of patients in the health care system will recieve this improved treatment. Due to a shortfall in state funding, the legislature limited state disease-management services for patients diagnosed with schizophrenia, bipolar disorder, or severe clinical depression. This potentially leaves many patients with anxiety disorders, eating disorders, obsessive-compulsive disorder, and less severe depression without services. However, officials are saying that alternatives will be provided for those that don't qualify for disease-management treatment. State services will be required to build adequate transition plans, to direct those not covered under disease-management to quality community health programs outside of the public system. However, such community programs appear to be few and far between, and the question is whether they will be able to adequately handle the new crop of incoming patients so that there is no break in care.

Another problem is that state funding does not even cover all the patients who legitimately qualify for disease-management. Some unfortunate mentally ill patients will keep recieving the bare minimum of care.

However, advocates are optimistic that with efficient implementation of disease-management, the program will eventually save the state money. And then, says Joe Lovelace of the National Alliance for the Mentally Ill, "we can go back and convince the Legislature that they won't be wasting money, that they can then add money...to add on for other illnesses."

Other mental health organizations across the country will be measuring the success of Texas's new plan in the near future.

For the full report, listen to the NPR All Things Considered segment (July 20, 2004). See http://www.npr.org/programs/atc/ for the audio file.

For more information about the future of disease management in the treatment of schizophrenia, see the pdf file published by the National Pharmaceutical Council (available at their website, http://www.npcnow.org/resources/disease/mental.asp)

To read more about the Texas Resiliency and Disease Management program for Mental Health, see the Texas Dept. of Mental Health and Mental Retardation website (http://www.mhmr.state.tx.us). Search for "resiliency and disease management."


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