Patient with serious mental illness or “SMI.”
A patient diagnosed with serious mental illness (or SMI) was coerced into signing up for a IHH (Integrated Home Health) program through one of the clinics managed by Magellan of Arizona – a Regional Behavioral Health Provider (RBHP) shortly after getting AHCCCS medical coverage. This on the basis that it would better help him manage his medical care and treatment for mental illness. This turned out to be anything but true.
The SMI patient, for example was never told of possible dangers between taking medications prescribed by a nurse practitioner at the clinic and possible interactions with Zoloft – a selective serotonin-reuptake inhibitors (SSRIs) he was taking at the time.
The SMI patient was assigned to the IHH at the Capitol Center – People of Color Network at 1540 W. Van Buren, Phoenix, Arizona.
The IHH is supposed to help coordinate care, but in this particular case they failed the client on numerous fronts.
First in prescribing Zoloft to a person with a medical diagnosis of high blood pressure (hypertension stage 2) and second by increasing that persons risk of heart attack by prescribing additional medications, including pain and sleeping pills which could interact negatively with his anti psychotic medication Zoloft .
Both of which should not have been prescribed to a SMI patient with a history of high blood pressure in the first place and are at an increase risk of heart disease.
According to the website goodtherapy.com:
“Zoloft should not be prescribed or taken if you have or have ever had a heart attack, heart disease, seizures, or liver disease, you should discuss this with your doctor before taking Zoloft. Zoloft may interact with other medications or supplements, including Antabuse (disulfiram), antihistamines, anticoagulants, antidepressants, antifungals, sleeping pills, St. John’s Wort, pain relievers, high blood pressure medications, migraine medications, and more” (source: http://www.goodtherapy.org/drugs/zoloft-sertraline.html).
In this case neither the psychiatric doctor prescribing Zoloft or the Nurse practitioner in charge of the IHH noticed that the patient was taking a combination of drugs which was making his condition worse.
According to Magellan website “IHH integrates mental and physical health care for the 14,000 Medicaid-eligible individuals in the central Arizona behavioral health system who are challenged with serious mental illness.”
IHH is a partnership of Magellan Health Services of Arizona, Maricopa Integrated Health System (MIHS), and central Arizona’s four adult SMI provider network organizations (PNOs): CHOICES Network, Partners in Recovery, People of Color Network and Southwest Network.
It was only after being enrolled in the IHH for a couple months and the patient began noticing a steady worsening of his medical condition for high blood pressure, that he began questioning his care – which went from stage 1 hypertension to stage 2 hypertension under the care of the IHH Nurse Practitioner assigned to this clinic.
Most worrisome in this case was the fact that none of the medical and psychiatric professionals involved in this patients case notice the problem or how serious it had become.
This same SMI patient also tried to discuss this situation with his IHH coordinator at the Capitol Clinic who blew him off and told him back to the nurse practitioner in charge of the clinic, who was the one actually responsible for his condition getting worse. She told the patient that she didn’t have time to discuss it and was busy.
This incident exemplifies how SMI patient care can be negatively affected if IHH providers are not doing due diligence and really looking at or properly managing a patients case – which is what happened here.