Preventive counseling for chronic disease: missed opportunities in a community mental health center.

Background: The tremendous burden of cardiovascular risk among persons with serious mental illness underscores a critical need for prevention. Counseling by primary care clinicians increases patient smoking cessation, physical activity, and the consumption of fruits and vegetables. The extent to which community mental health clinicians counsel about cardiovascular risk factors has not been reported.

Methods: This cross-sectional study examines the rates of counseling about cardiovascular risk factors by mental health providers at an urban community mental health center (n = 154). Logistic regression analyses identified clinician characteristics associated with counseling more than 50% of clients about diet, exercise, and smoking.

Results: 72% of clinical staff members responded to the survey, for a sample of 154 mental health clinicians; 26.6% of the clinicians counseled more than half of their clients annually about all three cardiovascular disease (CVD) risk factors. Logistic regression showed that mental health providers who counseled clients about CVD risk factors were less likely to be obese, and were more likely to have received formal training about how to counsel clients about CVD risk.

Discussion: This is the first study to examine the routine clinical practice of community mental health clinicians in addressing CVD risk at an urban community mental health center. Both training mental health clinicians about CVD risk and also support for improving clinician health status may improve the preventive care provided to clients at community mental health centers.