Reaching patients with serious mental illness (SMI) has traditionally been a challenge for the medical community.
In fact, only 64.5% of patients with SMI received mental health treatment in the past year, according to the National Institute of Mental Health (NIMH). One of the biggest hurdles for the medical community at large is gaining the trust of patients with SMI.
A new company, dubbed firsthand, is looking to transform SMI care using a peer-support model to help patients access care.
“A lot of the individuals that are struggling with serious mental illness and have very high costs of care are unengaged,” Samir Malik, CEO of firsthand, told Behavioral Health Business. “Often it’s because trust has been broken. Providers have mistreated them, and so they’re not always inclined to want to seek care. And where the magic of the peer comes in is the ability to say, ‘I am a living example of recovery.’”
How it works
Peer-support specialists, named firsthand guides, have a lived experience with a serious mental illness. New York-based firsthand trains these guides on outreach techniques. It also supports them to obtain a peer-specialist certification in their state, if they do not already have one.
Unlike the traditional model of care where a patient comes into an office to see a provider, firsthand guides go to the patient’s home. That home may be a shelter, group home, church or private residence.
When firsthand guides meets with patients, they take into account that these individuals may have experienced trauma in their lives. Additionally, they consider how patients may have had negative experiences with the health care system in the past.
“We have to establish a feeling of safety. We do this through making people feel safe to talk to us, … to reveal things about themselves. That’s part of the trust-building process,” Patrick Hendry, vice president of peer services at firsthand, told BHB. “We have to do what we say we’re going to do, never say we can do something unless we’re sure. … We have to be extremely transparent about why we’re there, who pays us, what information we have, and then what we can provide to them in terms of value.”
After patients decide to engage with peer-recovery specialists, the organization connects them to a firsthand benefit-enrollment specialist, which the organization calls community resource guides. This team helps patients navigate paperwork and enroll in the benefits that they are eligible for. In addition to health insurance, this could include housing support, nutrition assistance and transit vouchers.
“It’s not a one size fits all,” Rebecca Williams, a community resource guide at firsthand, told BHB. “We’re going out and finding out what the barriers are and what’s going on with that individual, because it’s unique and different to each one.”
firsthand connect its members to a nurse practitioner, called a health guide. It is this team member’s job to assess the patient’s holistic health including both physical and mental health needs.
firsthand also uses digital tools to help streamline programs and track data. However, Malik stressed that the company is a technology-backed provider and not a tech-focused company.
The business model
Founded in 2021, firsthand currently has contracts with three states: Tennessee, Ohio and Florida. By the end of the year the organization will be operational in seven markets across those states.
The company is prioritizing the Medicaid sector, where the need and expense is the highest, Malik said.
The economic burden of SMI is more than $300 billion each year, according to SMI Advisor. firsthand uses a value-based care approach to help curb these costs.
“We go to our health plan and say these individuals who are unengaged and struggling with serious mental illness, they cost you $30,000 on average last year,” Malik said. “For every one that we engage, and start finding a pathway to recovery and getting them the right benefits, … if they cost you $20,000 next year, let us share in that savings.”
Malik noted that the savings are enough to ensure that firsthand can continue to invest in initiatives like knocking on doors of clients, providing transportation and training peers.
“It’s not rocket science. These individuals are unengaged and trust needs to be built to re-engage them,” Malik said. “If we do that and plug them into the right services and the right supports, and help them all along the way, then their outcomes improve considerably. The cost of care comes down materially. And as a result, we can invest in what we’re doing.”
While Malik remained tight-lipped about funding, according to Crunchbase the startup has $14.8 million in capital.
Firsthand isn’t the only newcomer looking to tackle issues related to serious mental illness. Founded by Dr. Thomas Insel, former director of the National Institutes of Health (NIH) Mental Health, and Dr. Giovannia Colella, co-founder of OODA Health, Brightline and Castlight, Vanna Health is looking to use a community-based for-profit approach to caring for patients with SMI.
Additionally, San Francisco-based Amae, is differentiating itself in SMI care by focusing on patients’ physical, psycho mental, and societal and community wellness.
Companies featured in this article:
