The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness

OBJECTIVES

Persons with serious mental illnesses (SMI) have elevated rates of comorbid medical conditions, but may also face challenges in effectively managing those conditions.

METHODS

The study team developed and pilot-tested the Health and Recovery Program (HARP), an adaptation of the Chronic Disease Self-Management Program (CDSMP) for mental health consumers. A manualized, six-session intervention, delivered by mental health peer leaders, helps participants become more effective managers of their chronic illnesses. A pilot trial randomized 80 consumers with one or more chronic medical illness to either the HARP program or usual care.

RESULTS

At six month follow-up, participants in the HARP program had a significantly greater improvement in patient activation than those in usual care (7.7% relative improvement vs. 5.7% decline, p=0.03 for group *time interaction), and in rates of having one or more primary care visit (68.4% vs. 51.9% with one or more visit, p=0.046 for group *time interaction). Intervention advantages were observed for physical health related quality of life (HRQOL), physical activity, medication adherence, and, and though not statistically significant, had similar effect sizes as those seen for the CDSMP in general medical populations. Improvements in HRQOL were largest among medically and socially vulnerable subpopulations.

CONCLUSIONS

This peer-led, medical self-management program was feasible and showed promise for improving a range of health outcomes among mental health consumers with chronic medical comorbidities. The HARP intervention may provide a vehicle for the mental health peer workforce to actively engage in efforts to reduce morbidity and mortality among mental health consumers.

Building illness in the white-collar workplace

An increasing incidence of "building illness" is being noted among white-collar workers due to the high pollutant content of air in modern energy-efficient office buildings. These buildings are hermetically sealed, mechanically ventilated, and contain many materials that give off a variety of toxic fumes and aerosols. Severe outbreaks of illness have also been traced to ventilation problems in sealed hospital buildings. Similarly, tightly sealed and well insulated private homes present many sources of toxic pollutants to homemakers. Recent studies linking increases in the frequency and duration of respiratory illnesses with increasing pollution levels warn us that increases in indoor pollution levels should be avoided in the white-collar workplace, hospital, and private residence. Unfortunately, the cost of adequate ventilation of modern air-tight buildings is high. However, proper planning must be conducted to foresee and correct the impact of energy management policies on the livability and healthfulness of the indoor environment.