People with serious mental illness (SMI) and substance use conditions
can benefit enormously from behavioral health care and primary care that incorporate a wellness approach.
People with SMI or substance use disorders are dying decades earlier than the general population, for a host of reasons:
- • Higher rates of cardiovascular disease, diabetes, respiratory disease, and HIV and other infectious diseases
- • High rates of smoking, substance misuse, obesity, and unsafe sexual practices
- • Poverty, social isolation, trauma and violence, incarceration, lack of coordination between mental and primary healthcare providers, prejudice and discrimination, side effects of psychotropic medications, and overall lack of access to health care, particularly preventive care
“In the wellness approach, a person is empowered to assume personal responsibility and be proactive in the preservation of his or her own health. ”
— Margaret Swarbrick, Ph.D., wellness expert and person with lived experience
A wellness framework can help address many of the factors contributing to premature death. This article highlights examples of strategies that behavioral and primary healthcare providers can adopt to make wellness an integral part of their work with consumers. It is the second article on wellness featured in Minority Fellowship E-Newsletter. For an overview of the wellness approach and the eight dimensions of wellness, see the first article, “Promoting Wellness for Better Behavioral and Physical Health
,” from the December 2017 issue
Be More Recovery Oriented
Wellness is grounded in the 10 principles of recovery
. Practicing these principles with consumers is perhaps the single most important way to promote wellness.
Engage More in Shared Decision-Making and Collaboration
SAMHSA defines shared decision-making (SDM) as “an emerging best practice in behavioral and physical health that aims to help people in treatment and recovery have informed, meaningful, and collaborative discussions with providers about their health care services.”1
Providers and consumers work together as partners to develop the plan of care that best meets consumers’ needs.
For additional information on SDM, see SAMHSA’ s report, “Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions
,” the SAMHSA–Health Resources and Services Administration (HRSA) HRSA Center for Integrated Health Solutions (CIHS) Shared Decision-Making Web page
and the SAMHSA Recovery to Practice initiative’s three Webinars and podcast
Help Consumers Identify Wellness Strengths and Needs
A variety of tools are available to facilitate conversations about wellness strengths and needs. An excellent resource is SAMHSA’ s “Creating a Healthier Life: A Step-by-Step Guide to Wellness
.” This free workbook explains the eight dimensions of wellness in plain English and walks consumers through an assessment of strengths and needs/next steps in each dimension.
Ask Consumers About Their Physical Health and About the Date of Their Last Visit to Their Primary Care Provider
On average, behavioral health agencies and providers find that consumers have not seen the primary care doctor named on their insurance card for 5 years or more.2
Share Consistent Messages
Examples of messages include the following:
Coordinate With Consumers’ Primary Healthcare Providers
- • People with behavioral health disorders are at higher risk of dying years earlier, on average, than the general population, mostly because of preventable, treatable physical conditions such as heart disease and diabetes.
- • The top three ways
to promote wellness are 1) follow a healthy lifestyle, 2) work with a primary care doctor, and 3) ask questions about treatments, test results, symptoms, and concerns.
- • You are not alone on your wellness journey! There is a wealth of support you can tap into.
There are many ways to go the extra mile in helping consumers:
Increase Your Health Literacy and Help Consumers Strengthen Theirs
- • With consumers’ permission, connect with their primary care providers about medications and treatment plans. Share SAMHSA’ s brochure “Information for General Health Care Providers: What Is Wellness?”
- • When consumers are taking psychiatric medications, be aware of glucose levels, weight loss or gain, blood pressure, sleep patterns, and metabolic levels.
- • Explain to consumers the importance of following up on medical test results, especially when they are taking psychiatric medications.
- • Talk about ways to improve health (for example, having a healthy diet, exercising daily, and avoiding nicotine, alcohol, illicit drugs, and misuse of prescription drugs or other substances).
- • Refer consumers to resources (e.g., smoking cessation tools) as needed, and follow up with them.
Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”3
Learn about consumers’ physical health conditions and about diseases common to the consumer populations your agency serves. Share appropriate information with consumers.
Coordinate With Peer Providers
SAMHSA defines a peer provider as “a person who uses his or her lived experience of recovery from mental illness and/or addiction, plus skills learned in formal training, to deliver services in behavioral settings to promote mind–body recovery and resiliency.”4
Peer providers can be invaluable as mentors and coaches, offering information, emotional support, and positive role modeling; as bridges, helping consumers communicate with health care providers and vice versa; and as navigators, assisting consumers in connecting with needed services. If consumers seem hesitant to follow-up with primary care appointments, with guidance from their primary care doctors, or with self-care, ask them whether they would be willing to meet with a peer provider.
Support Consumers in Designing and Carrying Out Their Own Wellness Recovery Action Plan
The personal wellness recovery action plan (WRAP) was created by Mary Ellen Copeland, author, educator, mental health advocate, and person with lived experience; and a group of 30 persons with lived experience in a workshop Dr. Copeland facilitated. It gives easy-to-follow instructions for developing a personal wellness toolbox, a daily wellness maintenance plan, a list of triggers and a triggers action plan, a list of early warning signs and an action plan, a list of signs that things are breaking down and an action plan, a crisis plan, and a postcrisis plan. (Studies of WRAP include Fukui et al., 2011; Cook et al., 2012; and Pratt et al., 2013.)
Pocklington (n.d.) notes that “…WRAP supports (without judgment) each individual’ s discovery or recognition of those things that personal experience has shown to support his or her personal wellness. WRAP’ s action plans aren’ t someone else’ s plan for the person nor a plan that has to be negotiated with a treatment team; they are simply the individual’ s chosen vehicles for taking personal responsibility to get what he or she wants out of life—truly self-determined, truly self-actualizing. In essence, WRAP is the embodiment of everything system transformation is supposed to be about.”5
1SAMHSA. (2017). Shared decision-making tools.
Rockville, Md.: Author.
OTHER RECOMMENDED READING
2Galbreath, L., & Koch, J. (2017). Recovery-oriented practices in integrated care settings: Lessons, resources, and tools (Part 4 of 4).
[Webinar transcript]. Rockville, Md.: SAMHSA/Recovery to Practice initiative.
3U.S. Department of Health and Human Services/Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Rockville, Md.: Author.
4SAMHSA–HRSA Center for Integrated Health Solutions. (n.d.). Peer providers.
Rockville, Md.: Authors.
5Pocklington, S. (n.d.). Wellness recovery action planning: The essence of a new paradigm.
Cook, J. A., Jonikas, J. A., Hamilton, M. M., Goldrick, V. Steigman, P. J., Grey, D., . . . Copeland, M.E. (2012). Impact of wellness recovery action planning on service utilization and need in a randomized controlled trial. Psychiatric Rehabilitation Journal 36(4), 250–257. doi: 10.1037/prj0000028.
Fukui, S., Starnino, V. R., Susana, M., Davidson, L. J., Cook, K., Rapp, C. A., & Gowdy, E. A. (2011). Effect of Wellness Recovery Action Plan (WRAP) participation on psychiatric symptoms, sense of hope, and recovery.
Psychiatric Rehabilitation Journal, 34(3), 214–222.
Heller, E. (2016). Using peers to improve mental health treatment.
Legisbrief 24(10). National Conference of State Legislatures.
Pratt, R., MacGregor, A., Reid, S., & Given, L. (2013). Experience of wellness recovery action planning in self-help and mutual support groups for people with lived experience of mental health difficulties.
Scientific World Journal, 180587.
SAMHSA. (2012). What’ s recovery? SAMHSA’ s working definition: 10 guiding principles of recovery.
Rockville, Md.: Author.
SAMHSA/Center for Mental Health Services (CMHS). (2010). Information for general health care providers: What is wellness? [10 X 10 Wellness Campaign Brochure]. Rockville, Md.: Author.
SAMHSA/CMHS. (2010). Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions. HHS Publication No. SMA-09-4371. Rockville, Md.: Author.
SAMHSA/CMHS. (2016). Promoting wellness: A guide to community action.
Rockville, Md.: Author.
SAMHSA/Center for Substance Abuse Treatment. (2005). Working definition of recovery and Description of systems of care elements. In National Summit on Recovery conference report. Rockville, Md.: Author.
SAMHSA. (Last updated 06/14/2017). Wellness Initiative. [Web page].
SAMHSA–HRSA Center for Integrated Health Solutions (CHS). (n.d.). Health and wellness. [Web page].
SAMHSA–HRSA CHS. (2016). “Wellness promotion: Integration, culture, and best practices.” [Webinar slides].
Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29(4), 311–314.
Swarbrick, M., & Moosvi, K. V. (2010). Wellness: A practice for our lives and work. [Guest editorial]. Journal of Psychosocial Nursing, 48(7).