Many services, one patient, one roof

Dianna Thompson often has felt like a piece in a puzzle no one could solve. She saw doctors for physical conditions that include epilepsy, diabetes and chronic pain and others for treatment of bipolar disorder and borderline personality disorder.

But one group of professionals seldom talked to the other.

"I was just running around from place to place. It was hard to coordinate," said Thompson, a 50-year-old Grand Rapids resident.

A $30 million West Michigan facility is changing all that, with an innovative approach that brings together medical, substance abuse and mental health treatment under one roof. Experts believe it could save millions of dollars by cutting emergency room use and inpatient treatment, while simultaneously improving patient welfare.

Opened in Grand Rapids in 2011, Heart of the City Health Center is a collaboration among Cherry Street Health Services, a nonprofit health care network; Touchstone Innovare, a mental health agency; and Proaction Behavioral Health Alliance, which offers substance abuse treatment.

"The promise of this is that it can substantially reduce emergency room visits and inpatient care," said Chris Shea, executive director of Cherry Street Health Services. "We are seeing some very clear early evidence of that."

Wayne County Chief Probate Judge Milton Mack sees potential as well. An outspoken advocate for reform of the state's mental health treatment system, Mack sees Heart of the City as a template worth considering across the state:

"I think it's a great idea. It's really what people need who face these difficulties."

Mack, who has served as a probate judge for 20 years, is pushing to change the standard for courts to direct involuntary treatment of mental illness, in order to promote early treatment and reduce crime related to mental illness.

All too often, Mack said, individuals with mental illness reach a crisis state before the system deals with them. Treatment by then is more costly and the consequences severe, especially with individuals who become highly unstable or violent and wind up in jail or prison, instead of getting treatment.

"The system is fragmented. It is set up so it doesn't start working until you are in really bad shape. The system just doesn't respond in a timely or thorough way at all."

Shea noted that treating chronic mental illnesses such as schizophrenia, bipolar disorder and severe depression can be a challenge for low-income patients. It may be further complicated by such physical ailments as asthma, heart disease and diabetes or substance abuse.

But treatment for one may not be coordinated with the other.

The center houses doctors, dentists, psychiatrists, psychologists, social workers, physical therapists and dietitians. Within a few years, it expects to treat about 27,000 low-income individuals.

About 600 patients are to be enrolled in a pilot program; most have mental illness.

Lynda Zeller, deputy director for behavioral health and developmental disabilities in the Michigan Department of Community Health, applauds any approach that extends comprehensive treatment for those with mental illness.

"It is certainly an innovative idea and one worth looking at," she said.

Pilot programs for local mental health courts, requiring offenders to take treatment, are showing promising results, she noted. A Michigan Supreme Court report evaluating the courts found improved mental health outcomes.

A study for the Michigan Association of Community Mental Health Boards estimates the state could save more than $50 million annually by offering early intervention and treatment of moderate mental illness instead of crisis treatment.

With state and local government strapped for cash, Zeller believes it makes sense to consider what programs like Heart of the City bring to the table. In the past four years, state dollars for mental health services declined by nearly $50 million, from $322 million in fiscal 2009 to $273 million in fiscal 2012. Studies of comprehensive treatment models elsewhere suggest such programs cost more money initially "but it returns money in the end," Zeller said.

"What's critical is that local players try to get together and find answers that fill the gap," Zeller said.

At Heart of the City, 53-year-old Frank Sykes of Grand Rapids calls the program "a godsend." Sykes suffers from chronic pain, diverticulitis, irritable bowel syndrome and schizophrenia.

Before he came there for treatment, Sykes said, "I was running around like a chicken without a head. Here, I can see all my doctors in one building.

"They have immediate access to each other. I love it."

Ted Roelofs worked for the Grand Rapids Press for 30 years, where he covered everything from politics to social services to military affairs. He has earned numerous awards, including for work in Albania during the 1999 Kosovo refugee crisis.