Invisible No More

How one alumna is pioneering a better way of treating mental illness.

A 2006 report, “Morbidity and Mortality in People with Serious Mental Illness,” shed light on some startling facts about populations living with severe mental illnesses. The research showed that persons with serious mental illness – schizophrenia, bipolar disorder, severe depression,   schizoaffective disorder, and borderline personality disorder, among others – die 25 years earlier than the general population, making it one of the largest health care disparities in the country.

Kathy Hollins Gregersen, ’76, an alumna who’s devoted her career to mental health,  was troubled by the report’s findings. With concrete data in hand, she became determined to make meaningful changes to address the disparity in care and positively impact the lives of those living with serious mental illness.

As executive director for Mental Health Resources (MHR), a nonprofit based in St. Paul, Minn., Gregersen works to do just that. The mission of MHR is to foster hope, health, and recovery for those affected by mental illness.

MHR uses innovative treatment models that include assertive community treatment, psychosocial rehabilitation, case management, integrated mental health and chemical dependency services, and permanent supportive housing in an effort to rebuild the strengths and competencies of each client they serve.

A Holistic Approach

Gregersen got her start in social work at Meredith College. She enrolled in a social work class purely out of curiosity, but the field took hold of her, leading her to eventually earn a social work certificate (the College now offers a Bachelor of Social Work degree) in addition to her bachelor’s degree in religion. Her interest in the discipline – and her educational experience at Meredith – prepared her to pursue a Master of Social Work from Virginia Commonwealth University, where she had the opportunity to complete her graduate internship in the mental health division of a Veterans Affairs hospital. She’s been working in the field ever since.

“Not only did I receive an excellent academic education [at Meredith], but I also learned the importance of collaboration,” Gregersen said. “A number of assignments and projects required a team approach. Learning the skill of working on a team and collaborating has been essential to my career.”

Also essential to her career was learning early about a theory that she said was cutting-edge for the time.

“Meredith taught the ‘systems theory’ approach to social work, which is holistic in its approach,” she said. “If one part of a family system or organization is dysfunctional, it has an impact on the rest of the system. Thus, you have to address and heal the entire system to have an impact.”

According to Social Work Program Director and Assistant Professor Joy Learman, the systems theory has become one of the fundamental theories used to explain the complex contexts of clients’ lives and guides social workers in how to effectively intervene to provide treatment.

“The theory is extremely widespread in social work nowadays,” said Learman. “While it’s no longer considered cutting-edge, it is a unique social work perspective.”

The theory has indeed been fundamental throughout Gregersen’s career. Using this approach to her work, she’s pioneered viewing mental health as an integral component of overall health and has been an advocate for integrating mental health services, including substance abuse services, into large health care systems.

“Health care cannot be effective if it does not integrate mental health,” she said.

Promoting Integrated Care

Gregersen has spent the majority of her career in Minnesota. Prior to her role with MHR, she served as a vice president for United Health Care and Medica Health Plan in the Minneapolis area. She worked with a number of large companies to design a set of mental health benefits for their employees and families and then applied the systems theory in her proposals.

“My recommendation has always been to have generous benefits for mental health and substance abuse for employees because difficulties in these areas are the top reason for absenteeism and low work productivity,” she said. “Having robust benefits was a good business decision for companies, while also being very supportive of their employees.”

Then, in 2005, she was tapped by Hennepin County, the largest county in Minnesota, to design a health plan specifically for persons with disabilities – especially for disabilities with mental illness. They wanted a program that integrated health care, social services, and public health.

She developed a consumer-driven model that is still in use today. The majority of enrollees are persons with mental illness. “The consumers have been thrilled because they have never had a health plan designed around their needs and the specific barriers to their care,” she said.

“Kathy provided remarkably innovative and collaborative leadership to the development of an effective mental health system of care in Minnesota,” said Glenace Edwall, Ph.D., former assistant commissioner of mental health for the MN Department of Human Services. “She’s brought fresh energy and new approaches to providing better mental health treatment to a major health plan, an urban county, and a large not-for-profit organization.”

Her current role as executive director for MHR has allowed her to continue her quest for better and more comprehensive care for the mentally ill. The day-to-day operations are managed by MHR staff, which allows Gregersen to focus on policy and strategy. “MHR has several strategic initiatives that I oversee,” she said.

Gregersen managed a partnership between MHR and Medica Foundation, the charitable giving arm of Medica Health Plans, a Minnesota-based nonprofit HMO. The Foundation awarded a three-year, $300,000 grant to MHR to expand Intensive Community-Based Services in Minneapolis and St. Paul.

The pilot program was funded to determine if addressing the social determinants for persons with mental illness would have an impact on health care costs. The program MHR developed provided three to six months of intensive case management to clients with serious mental illness who were living with any combination of medical diagnosis, substance abuse, and/or chronic pain.

The results were undeniable. The program blended medical, dental, and mental health care with substance abuse treatment and provided connections to comprehensive human services such as housing security, vocational training, and transportation support. An analysis of claims data for the population served through the pilot program revealed a 50% reduction in health care costs over a six -month period.

In addition, inpatient hospitalizations and emergency room visits decreased, while filling of prescribed medications increased.

The project’s success was summed up in MHR’s 2014 Annual Report: “This project demonstrated an excellent return on investment regarding medical cost and increase in overall client health.” Gregersen said the organization plans to work with other potential providers and seek additional funds to expand this model in the future.

“This [project] supports the systems theory I learned at Meredith,” she said. “One needs to address the system as a whole, and it will have a positive impact on other areas.”

Another initiative Gregersen oversees is a smoking cessation plan. “The State of Minnesota and local health plans won the first landmark case against ‘Big Tobacco,’” she said. The settlement paid for numerous smoking cessation programs, which have resulted in reductions in tobacco use statewide among the overall population – but not among those with serious mental illness.

“The current statistics show that three out of four smokers in Minnesota are persons with serious mental illness,” she said. To address the gap, Gregersen and her team at MHR developed two different psychoeducational groups specifically for this population, depending on whether they want to reduce or discontinue tobacco use.

“These programs are longer than tobacco cessation programs for the general population,” she said. “And we connect the clients with more intensive resources for treatment.”

Gregersen and her staff also devised a dental initiative specifically for the unique population they serve.

“The medications to treat schizophrenia, bipolar disorder, depression, [and other mental illnesses] can cause the mouth to become very dry. This can cause gum and dental problems over a period of time, which greatly impact overall health,” she said.

MRH selected a few local dental clinics to provide care to their clients. “We chose these particular clinics because they understand that working with our clients requires a higher level of engagement – which takes more time and more patience.”

MHR is able to offer this kind of programming thanks to funds raised through its first-ever fund-raising campaign, Invisible No More.

“MHR is fortunate to be financially stable,” Gregersen said. “However, traditional financial margins have not allowed us to pursue some pilot programs. Invisible No More has supported the tobacco reduction program and dental initiative for our clients.”

The fundraising efforts have also funded a data warehouse, which stores information about clients that allows the organization to make informed decisions. “The campaign has helped us to think and act more broadly,”
she said.

For the last two years, Gregersen has been part of a statewide workgroup tasked with designing “Behavioral Health Homes.” These plans were presented to the state legislature and passed during the most recent legislative session, and will be fully implemented in July 2016.

“This means that a mental health organization can provide and coordinate medical care for persons with a serious mental illness with a reimbursement rate that covers the cost of doing so,” she said. “I am currently working with a large local health plan to design a new service model that combines treatment and human services to this population.”

Fighting Stigma

In addition to implementing programs, addressing the stigma associated with mental illness is highly important for Gregersen.

“Stigma remains a significant issue for persons with mental illness,” she said. The work MHR performs is community-based, which addresses the stigma head on. “We see clients in their homes or anywhere in the community that works best for them. We want our clients to remain living and working in the community rather than in institutions and state hospitals.”

Gregersen knows the importance of not only securing housing for her clients, but making sure they understand the responsibility having a home entails. “We teach them what a lease for an apartment means and what they have to adhere to in order to maintain their housing,” She said. “We have relationships with landlords who can call on us if there is any difficulty.”

“We also help our clients secure jobs,” she added. “Some of the jobs are volunteer positions, but it is important for our clients to have meaning in their lives and to contribute to the community. The more exposure the community has to our clients, the more the stigma lessens.”

As the stigma lessens and broad, comprehensive care becomes more accessible thanks to the work of innovators like Gregersen, statistics such as those found in the 2006 report that she found so troubling should improve.

As Gregersen continues to advocate for better care for those with mental illness, she reflected on her rewarding career.

“I love my job,” she said. “I have no regrets in choosing this path.”