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Editor's Note
December 2015

Improving the Health of Persons With Serious Mental Illness

JAMA Intern Med. 2015;175(12):1979-1980. doi:10.1001/jamainternmed.2015.6159

Persons with serious mental illness have a high rate of early mortality. Contributing factors include increased prevalence of smoking and other forms of substance abuse, sedentary lifestyle, and adverse effects of psychotropic medication use. These greater risks for premature death are compounded by poor access to medical care. Some individuals with serious mental illness are uncomfortable seeking care at physical health sites, and most mental health sites do not have the capability of providing needed physical health care.

This problem is well illustrated in the study by Mangurian et al1 in this issue of JAMA Internal Medicine. The authors used California Medicaid data to identify patients who were prescribed an antipsychotic medication. They then assessed what percentage of the patients had some form of glucose screening, a recommendation by the American Diabetes Association2 for persons taking antipsychotic medications, in a yearlong period. Overall, 30.1% of individuals were screened. It would be fair to point out that the efficacy of screening for diabetes has not been well established. However, that less than one-third had such screening for a known adverse effect of antipsychotic medication use suggests opportunities for improvement in integrated health care. Among those who had at least 1 primary care visit during the year, the proportion screened was significantly higher at 35.6% vs 19.8% for those who had no primary care visit.

To improve care for persons with serious mental illness, it will be necessary to break down the silos that separate the mental health and physical health care systems. Integrated care (care provided by a team of physical and mental health clinicians)—or at least colocated care (care provided by physical and mental health clinicians in the same place)—offers the promise of improving the physical health of individuals with mental illness, as well as the mental health of those seeking physical health services.

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Conflict of Interest Disclosures: None reported.

References
1.
Mangurian  C, Newcomer  JW, Vittinghoff  E,  et al.  Diabetes screening among underserved adults with severe mental illness who take antipsychotic medications [published online November 9, 2015].  JAMA Intern Med. doi:10.1001/jamainternmed.2015.6098.
2.
American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity.  Consensus development conference on antipsychotic drugs and obesity and diabetes.  Diabetes Care. 2004;27(2):596-601.PubMedArticle
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