Physical wellness: an integral feature of recovery.

Five years have passed since the publication of a landmark report by the National Association of State Mental Health Program Directors, calling attention to the high morbidity and mortality associated with psychiatric disabilities (Parks, Svendsen, Singer, & Foti, 2006). On average, people with serious mental illnesses die 25 years earlier than the general population, and 60% of these deaths are due to preventable, treatable medical conditions such as cardiovascular disease, diabetes, and high blood pressure. Access to medical treatment and coordination of care is also poor due to inadequate insurance coverage and a dearth of effective models for care integration. Another issue is lack of affordable care, with “safety net” health care clinics at full capacity, and many disadvantaged communities having few or no health care providers. People in recovery report stigma and discrimination from health care providers, while providers themselves express discomfort and lower expectations that these patients can be partners in their own care. Inadequate health care coverage is made even worse by antiquated Medicaid reimbursement policies with restrictions such as prohibitions against billing for both medical and mental health services on the same day. Perhaps not surprisingly, the health care people do receive is of demonstrably poor quality, with little attention to prevention, health monitoring, and adherence to evidencebased treatment guidelines.