The CEO of Genesee County Community Mental Health in Flint, Mich., knew he was going against the grain in 2009 when he vowed to devote agency resources to pairing seriously mentally ill clients with personal trainers. Dan Russell would hear staff members wonder aloud what had convinced him to alter his thinking about treatment and recovery, hire “gym teachers” over mental health therapists, and allocate precious dollars from the agency’s general fund for that purpose.
What convinced Russell was what he had seen while attending a New Hampshire training session organized by the agency that launched the InSHAPE program in 2003. Based on what he calls “amazing unscripted testimony” from clients at Monadnock Family Services in New Hampshire, Russell realized that he had an opportunity with InSHAPE not only to be of service to clients, but to transform their lives.
“This was something I couldn’t ignore,” says Russell. “This is going to keep people from dying.”
Genesee County Community Mental Health two years ago joined a very small but highly committed group of community mental health centers (CMHCs) that have adopted the InSHAPE model established by former Monadnock Family Services CEO Ken Jue. The impetus for the effort lies in the well-known national data showing that individuals with serious mental illness on average die 20 to 25 years sooner than the general population, often from the effects of chronic illnesses exacerbated by a sedentary lifestyle.
The success of InSHAPE is founded on the relationship that is built between a client and a personal trainer. This relationship not only gives the client extra motivation to begin living healthier, but the partnership also helps combat the isolation experienced by many individuals with schizophrenia, bipolar disorder and other serious mental disorders.
For this population in general, “Classes and brochures don’t help—you need personal interaction,” says Shanté Burke, who gave up working in fitness centers to work with the seriously mentally ill at the Michigan agency. Burke is Genesee County Community Mental Health’s manager for health and wellness.
Burke, who has a degree in kinesiology, says in comparing her current job to working with the typical gym member population, “This is definitely more beneficial; we can help add years to a person’s life. Every individual has an opportunity for a better life.”
Jue, who has remained a consultant to Monadnock Family Services since leaving the CEO role there two years ago, has said that the idea for InSHAPE stemmed from his attending one in what seemed like a never-ending series of funerals for relatively young Monadnock clients around 2002. Because his staff was unable to find any examples of mental health centers that had adopted comprehensive fitness initiatives for clients, Jue decided to create a program from scratch.
At Monadnock Family Services, Jue set out to establish fitness options for clients in the community, rather than creating a “clients-only” fitness center that he believed would simply reinforce the isolation these individuals experience. Monadnock negotiated discounted memberships for its clients at a number of local health clubs. Along the way, Jue cemented other partnerships, such as when a Dartmouth-Hitchcock medical clinic agreed to offer primary care services to InSHAPE participants.
At several of the handful of CMHCs that have replicated the InSHAPE model, clients will begin working with trainers at an on-site fitness area in the agency, then will move to a fitness center in the community. At Genesee County Community Mental Health, many clients spend about four weeks in sessions at an on-site wellness center before moving to a recreation center on the University of Michigan’s Flint campus.
The personal trainers generally are contract workers to the mental health agencies, with their fees representing most of these programs’ costs. Before working with clients, Russell says that trainers for his agency receive two weeks instruction, based on the Mental Health First Aid curriculum, so that they better understand mental health symptoms and other issues associated with this population.
The Genesee County agency refers to the trainers as “health mentors,” reflecting its InSHAPE program’s three focal points: physical activity, nutrition guidance, and management of chronic physical illness. Each health mentor works with about 30 clients.
Burke says the fitness level of consumers varies widely, from former athletes to individuals who “never have done a jumping jack.” Clients may volunteer for the program or be referred by a case manager. There’s no shortage of interest: Genesee County Community Mental Health recently had a waiting list of around 100 consumers and was looking to hire more health mentors.
Agencies that have adopted InSHAPE have been somewhat successful in billing Medicaid for a portion of their program costs, as some of the activities fall under accepted definitions for client symptom control. Russell says 56 percent of his agency’s InSHAPE program costs fall under a Medicaid code. But funding support for the remainder of program expenses has been harder to find.
“It’s not mental health counseling, so it’s a little out of the box,” says Russell, explaining the conventional thinking of some funders.
In New Hampshire, however, where six community mental health agencies either have implemented or are about to launch InSHAPE initiatives, funding has been bolstered by a five-year, $10 million commitment from the Centers for Medicare & Medicaid Services (CMS) to extend the model across the state.