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How to Manage Chronic Mental Illness with Chronic Care Management

The psychological strain placed on patients with chronic illnesses is enormous and, unfortunately, can easily be overlooked. When initially diagnosed with a chronic condition, patients often must make radical lifestyle alterations to preserve their health and encourage positive clinical outcomes. 

These patients’ schedules can become filled with screenings, lab work, and appointments with various specialists. Their healthcare costs often escalate, and they must grapple with budgeting for newfound and recurring medical expenditures. Chronic illnesses may also cause functional limitations, fatigue, and disabilities that impede a patient’s ability to pursue professional aspirations, relationships, and hobbies. 

Given the overwhelming and distressing changes that often accompany chronic diseases, it is unsurprising that there is a profound link between chronic physical illness and chronic mental illness. The Centers for Disease Control (CDC) reports that diabetic patients are 2 to 3 times more likely to develop depression than their non-diabetic counterparts. The CDC further documents that approximately 75% of cancer patients struggle with mental health issues and that heart disease patients with mental illnesses are at increased risk of disease complications and exacerbation.

Healthcare professionals must address the mental well-being of their chronically ill patients to ensure optimal health outcomes. A holistic approach to health is critical to facilitating maximized quality of life for the patient. 

In this article, we will explore how Chronic Care Management (CCM) helps providers deliver exceptional, person-centered care to patients managing multiple chronic illnesses by addressing the physical and mental challenges patients face. We will further discuss how Behavioral Health Integration (BHI) can dismantle accessibility barriers and encourage greater engagement in mental health services.   

What is chronic mental illness?

Chronic illnesses are broadly defined as diseases expected to last at least a year and that require ongoing medical attention and intervention. Depression and anxiety disorders are the most common chronic mental illnesses, but the label also includes substance abuse disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), bipolar disorder, and schizophrenia.  

Chronic mental illnesses can present moderate to debilitating psychiatric symptoms that can interfere with a patient’s ability to navigate their healthcare journey, professional career, education, and interpersonal relationships. Chronic mental illnesses present a broad range of symptoms that differ greatly depending on the patient. These symptoms can range from fatigue, anhedonia, and panic attacks to hallucinatory delusions, suicidal ideation, and manic episodes.   

Though chronic illnesses are typically associated with physical diseases, like diabetes, hypertension, or arthritis, untreated chronic mental conditions are often just as damaging to a patient’s health and long-term clinical prospects. They can also greatly exacerbate pre-existing medical conditions. Chronic mental illnesses, like depression and anxiety, may cause a patient to abandon wellness goals, discontinue medications, and isolate themselves from their community.  

Like most chronic illnesses, mental health conditions often require lifestyle adjustments and active patient engagement to control and manage the illnesses successfully. This can include psychotherapy, medication adherence, establishing new dietary and physical exercise routines, increasing social activity, and proactively addressing Social Determinants of Health (SDOHs). 

What are the types of chronic mental health problems?

There are many types of chronic mental health problems, each with a unique set of physical and psychological symptoms, risk factors, and treatment plans. These chronic mental illnesses include: 

• Anxiety disorders
• Bipolar affective disorder
• Depression
• Dissociative disorder
• Eating disorders
• Obsessive-compulsive disorder (OCD)
• Personality disorders
• Post-traumatic stress disorder (PTSD)
• Psychotic disorders
• Schizophrenia 
• Substance abuse, impulse control, and addiction disorders

All chronic mental illnesses can affect everyone, regardless of age, ability, gender, or health status. However, research demonstrates explicitly that patients with chronic illnesses are most at risk of developing depression and anxiety disorders. Additionally, the World Health Organization (WHO) found that 14% of adults over the age of 60 are living with at least one mental health condition. The WHO further notes that while mental illness is prevalent among this older population of adults, it is frequently poorly discussed, undertreated, and surrounded by social stigma. 

The relationship between chronic disease and mental health

Chronic illnesses often fundamentally alter a patient’s life. Many patients may lose mobility due to their conditions and, as a result, sacrifice some degree of their independence. Other patients live each day battling chronic pain, inflammation, or fatigue. Many chronically ill patients must adapt to brand-new diets, exercise routines, and increased engagement with medical services. Disability, chronic pain, and fatigue can all make implementing these changes even more burdensome and exhausting. Patients may also face increased healthcare costs, which can place additional strain on those already facing financial hardships.     

These dramatic changes and challenges can understandably trigger feelings of grief, guilt, and despair in patients. It is normal for patients to experience feelings of sadness and mourning after new diagnoses, and through early, preventative therapeutic interventions, many patients can work through these difficult emotions and approach their newfound limitations with hopefulness and energy. However, when these emotions are unaddressed in a constructive manner, they can progress into chronic clinical depression and anxiety, which can further debilitate and discourage a patient. 

Research reveals the urgency of treating mental health with the same dedication and rigor as physical health. Patients with severe mental health issues have a life expectancy of around 25 years less than others. What is even more sobering is that these premature deaths are primarily the result of preventable diseases. Patients with poorly managed mental illnesses are far less likely to adhere to treatment plans for cardiovascular diseases and diabetes and face deteriorating health that could be avoided through targeted, thoughtful intervention. 

Therefore, the medical community must increase its focus on managing the patient’s health through a holistic, individualized, and person-centered lens. Care management programs like Chronic Care Management (CCM) and Behavioral Health Integration (BHI) are two solutions commonly deployed by providers across specialties and practices. CMS created these care management programs to help deliver a personalized fusion of mental and physical care to vulnerable Medicare patients.

Learn more: 5 Reasons to Offer Integrated Behavioral Health Services 

Chronic disease and depression 

One of the most common complications of chronic illness is depression. According to the Cleveland Clinic, approximately one-third of patients diagnosed with a chronic disease will experience symptoms of depression throughout their wellness journey. 

When coupled with other chronic illnesses, depression can quickly create a vicious cycle. The challenges of chronic physical diseases can incite depressive episodes. Depression can worsen fatigue, isolation, pain, and negative emotions and thought patterns. This, in turn, can aggravate the patient’s other chronic illnesses and discourage them from pursuing effective self-management and healthy routines. 

For example, studies find that diabetic patients struggling with depression demonstrated poorer medication adherence, worse glycemic control, and limited physical activity. These patients also had higher rates of tobacco use, consumption of high-fat diets, and diabetes-related organ complications. 

Managing depression is crucial to ensuring that a patient is emotionally and mentally equipped to manage their other illnesses and pursue a fulfilling, enriching life. 

Chronic disease and anxiety

Chronic illnesses can also provoke intense feelings of anxiety in patients. Patients may be fearful of their futures and the potential medical emergencies, chronic pains, disabilities, and surgical interventions caused by their illness. They may also worry about the financial implications of their diagnosis. Managing a chronic disease can be extremely expensive, especially for those uninsured or underinsured. Even those with insurance, like Medicare recipients, can face immense healthcare-related costs. Diabetic patients incur medical expenses 2.6 times higher than those without the disease, averaging a staggering $19,736 annually per patient. Patients may also develop anxiety about the ramifications their illness will have on their loved ones and community, their professional careers, and their capacity to pursue their passions. 

While it is normal for patients to experience heightened anxieties about their health in the wake of a life-changing diagnosis, if left ignored and untreated, the disorder can become pathological and make it difficult for patients to function in the world. This can have disastrous consequences for a patient’s quality of life and prevent them from managing their other illnesses successfully.   

How Chronic Care Management benefits patients with mental illness

Chronic Care Management (CCM) is a value-based care program that assists patients in managing multiple chronic illnesses through personalized wellness plans, routine communication, care coordination, and ongoing education and engagement. CCM is offered to Medicare Part B beneficiaries with two or more qualifying chronic illnesses. While CCM commonly is used to aid patients in managing diseases like diabetes and hypertension, depression, anxiety, and other mental illnesses are also covered by the service. 

CCM excels at assisting patients with complex conditions. The program  helps patients manage their illnesses, improve their quality of life, and facilitate positive clinical outcomes. CCM keeps patients consistently involved with their care journey, allowing for targeted and timely interventions and the closure of care gaps. This elevated level of care can be especially beneficial for patients who are dealing with a mental illness in addition to a physical illness. 

Learn more: A Provider’s Guide to Chronic Care Management

4 ways to manage chronic mental illness with CCM

1. Provide patients with human connection 

Mental illnesses are still stigmatized for many people, especially older patients. These patients may lack the vocabulary to articulate their mental health issues, fear that mental health struggles are a sign of weakness, or simply believe that depression and anxiety are normal parts of aging. Older patients are also at increased risk for social isolation, meaning they may not have a community available to listen to them process their concerns and struggles verbally. Social isolation also places patients at increased risk for premature death from all causes.   

CCM provides a safe space for these patients to discuss their mental illnesses with compassionate care managers without risk of judgment or backlash. Each month, enrolled CCM participants will receive a call from their assigned care manager, where they can freely discuss their symptoms, concerns, and obstacles. Care managers can assist them with provider-approved self-management advice and escalate more severe issues to an appropriate medical professional. 

Patients enrolled in a CCM program also have access to a 24/7/365 nurse care line, giving them direct access to a healthcare professional regardless of the day or time. Patients experiencing mental health crises can use the care line to reach a medical professional who can guide them on the appropriate next clinical steps. 

This simple cadence of reliable human conversation can be transformative for those dealing with depression or anxiety. Providing patients with an outlet to discuss their mental illnesses can relieve the feelings of doubt, hopelessness, and seclusion that often accompany depression and anxiety disorders.   

2. Encourage medication adherence through monthly communication

Patients with chronic mental illnesses are often prescribed medications to help them manage their depression and anxiety. These pharmaceutical treatments must be taken regularly and responsibly, as unsupervised discontinuation can exacerbate mental health problems. 

A provider may not know if a patient has stopped taking their medication until months later, but, through monthly communication, care managers can identify these changes quickly. They can then engage patients in a dialogue about why they’ve chosen to stop their medications and encourage them to reconsider or return to their healthcare provider to find a more suitable alternative. 

Since patients enrolled in CCM manage multiple conditions, they are often prescribed other medications to control symptoms like their blood pressure or glucose levels. Patients struggling with depression may have stopped taking these life-saving drugs because of lethargy or despair. The frequency of CCM communication allows care managers to intervene and encourage patients to adhere to their medications. They can further support these patients with medication refills and deliveries if needed.   

3. Assist patients with managing SDOHs 

Social Determinants of Health (SDOHs) have enormous implications on patients' physical and mental health. Socioeconomic status, education level, religious and cultural affiliations, geographic location, and access to care are just a few social factors that influence a patient’s health and long-term clinical prospects. 

Housing instability, a lack of access to food and reliable transportation, and living in a high-crime area can all dramatically exacerbate pre-existing mental illnesses. Patients hoping to manage their mental illnesses must also address the social and environmental factors that contribute to their well-being. This can be difficult for patients to achieve on their own, especially if their mental health conditions leave them debilitated. 

Fortunately, CCM programs are adept at assisting with the SDOH needs of their enrolled patients. CCM care managers conduct comprehensive patient screenings to detect risks like housing stability, food security, and transportation access. If they identify a potential barrier to care, they can collaborate with the patient and healthcare providers to address these obstacles. 

For example, care managers can arrange transportation to and from appointments for patients, ensuring that gaps in care don’t emerge. They can refer patients to local community organizations to assist with housing assistance, food access, and social services to alleviate financial pressures. They can also connect patients with exercise classes tailored to their age and ability, volunteer opportunities, and community classes and activities to facilitate positive social interactions.    

4. Engage patients in preventative care 

Patients struggling with depression or anxiety may be disengaged with their healthcare journey due to fear, fatigue, or feelings of hopelessness. This can mean failing to schedule routine bloodwork and physicals, avoiding preventative cancer screenings, and missing important vaccinations. These preventative care services facilitate positive chronic disease management, reduced healthcare costs, and superior quality of life. This is especially true when patients are already balancing multiple chronic conditions. 

CCM programs educate and engage patients in their healthcare journey, emphasizing preventative care. CCM care managers can assist patients in scheduling appointments, accessing test results, and coordinating care between disparate practices and healthcare networks. Care managers can review each patient’s risk factors and encourage them to pursue the appropriate screenings based on their health history, lifestyle, and wellness plans. 

Suppose a patient is reluctant to follow through on these recommendations. In that case, the care managers can use these monthly calls to inform the patient of the importance of preventative care and motivate them to pursue an optimal future for their physical and mental health. 

Learn more: The Challenges of Delivering High-Quality Care to Patients with Chronic Conditions

Behavioral Health Integration: Expanding access to mental healthcare 

In addition to a robust CCM program, Behavioral Health Integration (BHI) is another powerful tool your practice can use to expand mental healthcare delivery. BHI is a collaborative approach to holistic, personalized care that broadens the scope of care a patient can receive at a single practice. 

BHI addresses mental health, substance abuse, chronic diseases, and social dynamics within the walls of a patient's primary care office. By offering mental health services through a familiar, trusted provider, BHI aims to overcome the stigma around these conversations and break down the barriers that many patients face when pursuing mental healthcare. 

Like CCM, BHI is covered under Medicare, making it available to over 66 million eligible recipients. This multidisciplinary, comprehensive approach to care is flexible and designed to fit seamlessly into your practice without disrupting pre-existing workflows. 

BHI and CCM pair together exceptionally well. Patients can receive mental health evaluations and care through BHI during their in-office visits, as well as regular check-ins outside of the office. For patients who don’t need BHI or have physical conditions as well, CCM helps patients adhere to their wellness plans between clinical visits, evaluates patients for new or worsening symptoms, and helps alleviate stresses that can exacerbate mental health conditions. 

Learn the CPT codes for Behavioral Health Integration.

Partner with ChartSpan and elevate your mental healthcare services 

ChartSpan is a national leader in CCM services. Our innovative turnkey program provides your practice with the tools and resources required to easily integrate CCM into your pre-existing workflow without the costs and time associated with implementing in-house CCM. From skilled enrollment specialists to compassionate care managers, we provide your practice with the necessary personnel to ensure that your CCM program is an ongoing success.

We have a long history of helping patients manage their chronic mental illnesses in addition to their physical conditions. Our care managers connect patients daily to financial resources, community engagement opportunities, and transportation access. They also build personal relationships with enrolled beneficiaries through invaluable human connection. This strengthens patient trust and satisfaction and paves the way to improved clinical outcomes and wellness plan adherence.

Partner with ChartSpan and transform how your practice delivers holistic care to chronically ill patients. Contact us to learn more about how we can help elevate your chronic mental healthcare. 

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