Persons with serious mental illnesses (SMI) have elevated rates of comorbid medical
conditions, but may also face challenges in effectively managing those conditions.
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.
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.
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.
Copyright (c) 2010 Elsevier B.V. All rights reserved.