The Interdependence of Mental The Interdependence of Mental Health and Physical HealthHealth and Physical Health
The case for creating integrated The case for creating integrated systems of caresystems of care
James Yoe PhD; Elsie Freeman MDMaine Department of Health and Human Services
SAMHSA National Grantee Conference Washington, DCJune 19, 2009
WHO Global Burden of DiseaseWHO Global Burden of Disease20002000
Chronic Diseases are a major cause of Chronic Diseases are a major cause of death and disability accounting for 25% of death and disability accounting for 25% of all disability worldwideall disability worldwide
Arthritis – Musculoskeletal DiseasesArthritis – Musculoskeletal Diseases
Respiratory DiseasesRespiratory Diseases
CardiovascularCardiovascular
DiabetesDiabetes
Behavioral Disorders Account for Behavioral Disorders Account for Even More Disability than Chronic Even More Disability than Chronic
Medical ConditionsMedical Conditions
WHO: 2000 Global Burden of Disease – In WHO: 2000 Global Burden of Disease – In the developed world, behavioral disorders the developed world, behavioral disorders account for almost half of burden of disabilityaccount for almost half of burden of disability
Mental Illnesses – 24%Mental Illnesses – 24%
Substance Use Disorders – 12%Substance Use Disorders – 12%
Alzheimer’s Disease/Dementias – 8%Alzheimer’s Disease/Dementias – 8%
And In Addition….And In Addition….
Persons with mental ill health have higher rates Persons with mental ill health have higher rates of health risk (smoking, obesity, physical of health risk (smoking, obesity, physical inactivity)inactivity)Persons with mental ill health have higher rates Persons with mental ill health have higher rates of diabetes, arthritis, asthma, heart diseaseof diabetes, arthritis, asthma, heart diseasePersons with both chronic disease and mental Persons with both chronic disease and mental illness have higher costs and poorer outcomesillness have higher costs and poorer outcomes
Mental illnesses and chronic medical diseases Mental illnesses and chronic medical diseases interact:interact:
Negative Negative Impact of Depression on Impact of Depression on the Outcome of Cardiovascular the Outcome of Cardiovascular
DiseaseDisease
Cardiovascular IllnessCardiovascular Illness Impact of DepressionImpact of Depression
Coronary artery diseaseCoronary artery disease 40% 40% risk of cardiac risk of cardiac eventsevents
Unstable anginaUnstable angina 3x 3x of cardiac death at 1 of cardiac death at 1 yearyear
Post-MIPost-MI mortality 4-6xmortality 4-6x
Congestive heart failureCongestive heart failure 50% survival vs. 78% 50% survival vs. 78% survivalsurvival
Negative Impact of Chronic Negative Impact of Chronic Medical Conditions on Recovery Medical Conditions on Recovery
from Severe Mental Illnessfrom Severe Mental Illness
On average persons with Serious Mental On average persons with Serious Mental Illness die 25 years earlier than their age Illness die 25 years earlier than their age mates in the general populationmates in the general population
Persons with SMI are not dying from their Persons with SMI are not dying from their mental illness but from heart disease, mental illness but from heart disease, diabetes and other medical conditionsdiabetes and other medical conditions
Death is the ultimate impediment to Death is the ultimate impediment to recoveryrecovery
The Gaps – disease and program The Gaps – disease and program specific structures are not person specific structures are not person
centeredcentered
Most data and management systems Most data and management systems focus on one or the other (and separate focus on one or the other (and separate mental illness from substance abuse or mental illness from substance abuse or from cognitive impairments) from cognitive impairments) Most systems of care (and regulation and Most systems of care (and regulation and reimbursement) focus on one onlyreimbursement) focus on one onlyInstitutional systems (federal, state, Institutional systems (federal, state, academic) are also separate from each academic) are also separate from each otherother
The GoalThe Goal
The goal of a transformed health system The goal of a transformed health system that integrates mental health and physical that integrates mental health and physical health promotion should be to put the health promotion should be to put the head and body back together so that head and body back together so that policies and programs are “person-policies and programs are “person-centered” or more holistic rather than our centered” or more holistic rather than our present system of carving out body parts present system of carving out body parts (i.e., oral health, reproductive health, (i.e., oral health, reproductive health, mental health etc.) or specific diseases mental health etc.) or specific diseases (i.e., diabetes, heart disease, stroke, (i.e., diabetes, heart disease, stroke, cancer, etc.).cancer, etc.).
Maine Data: Maine Data: The Impact of Mental Illness on The Impact of Mental Illness on Physical Health in the General Physical Health in the General
PopulationPopulation
Expanding focus of SMHA, Medicaid Expanding focus of SMHA, Medicaid and Public Health to mental health and Public Health to mental health
issues in the general populationissues in the general population
Maine Examples of Integrated Maine Examples of Integrated Data AnalysisData Analysis
Integrated analysis of Mental Health Integrated analysis of Mental Health Modules in BRFSS Modules in BRFSS
Integrated analysis of Medicaid data – the Integrated analysis of Medicaid data – the Maine/SC Emergency Room Usage studyMaine/SC Emergency Room Usage study
Maine BRFSS Mental Illness Modules Maine BRFSS Mental Illness Modules Frequent Mental Distress (FMD):Frequent Mental Distress (FMD): ≥≥ 14 days mental ill health 10.7% 14 days mental ill health 10.7%
Depression and Anxiety ModuleDepression and Anxiety ModuleModerate/Severe Current Depression – 7.4%Moderate/Severe Current Depression – 7.4%Past history of depression – 20%Past history of depression – 20%Past history anxiety disorder – 16%Past history anxiety disorder – 16%
K-6 ModuleK-6 ModuleSerious Psychological Distress (K6 Serious Psychological Distress (K6 ≥ 13)≥ 13) - 3.8% - 3.8% Moderate Psychological Distress (K6 – 8-12) - 7.8%Moderate Psychological Distress (K6 – 8-12) - 7.8%History of Mental Health Treatment -15%History of Mental Health Treatment -15%Miss Most Days Activities - 3.1%Miss Most Days Activities - 3.1% Miss Some Days - 6.8% Miss Some Days - 6.8%
No one definition includes all persons – overlapping, No one definition includes all persons – overlapping, but non-identical populationsbut non-identical populations
Conclusion from Integrated Conclusion from Integrated Analysis of Maine BRFSS DataAnalysis of Maine BRFSS Data
Mental ill health affects one in five Mental ill health affects one in five Mainers, touching every social networkMainers, touching every social network
Mental ill health is associated with higher Mental ill health is associated with higher rates of health risk, chronic disease and rates of health risk, chronic disease and poor self care in the general populationpoor self care in the general population
Attention to mental health issues critical Attention to mental health issues critical for systems that target chronic disease for systems that target chronic disease
Maine DHHS /South Carolina Maine DHHS /South Carolina ER StudyER Study
Integrated Analysis Integrated Analysis Medicaid Services DataMedicaid Services Data
Population StudiedPopulation Studied
Medicaid only, 11 or 12 months eligibility, 19-64 Medicaid only, 11 or 12 months eligibility, 19-64 years oldyears old
Group placement is dependent on whether there Group placement is dependent on whether there was any SA or MH diagnosis for any claim in the was any SA or MH diagnosis for any claim in the fiscal yearfiscal year
Four groups: MH, SA, MH & SA, no MH/SAFour groups: MH, SA, MH & SA, no MH/SA
ER visit diagnoses are primary diagnosis given for ER visit diagnoses are primary diagnosis given for the ER visitthe ER visit
ER utilization is # of visits per 1000 members in ER utilization is # of visits per 1000 members in each specific groupeach specific group
ER Utilization Rates Increase ER Utilization Rates Increase with Complexity of Groupwith Complexity of Group
17301680
880
3910
615
11231394
3011
0
1000
2000
3000
4000
5000
No MH/SA Dx MH Dx SA Dx MH & SA Dx
Maine SC
Overall ER Usage Increases with Overall ER Usage Increases with Complexity of Underlying PopulationComplexity of Underlying Population
ER utilization rates 2 times higher for MH ER utilization rates 2 times higher for MH or SA only groups compared to Medicaid or SA only groups compared to Medicaid members with no behavioral health members with no behavioral health diagnosesdiagnoses
ER rates are 4 times higher for Co-morbid ER rates are 4 times higher for Co-morbid MH/SAMH/SA
What is primary reason What is primary reason for going to the ER?for going to the ER?
Percent Maine ER Visits by Percent Maine ER Visits by Diagnosis by GroupDiagnosis by Group
5.8
76.4
17.8
5.1
73.1
21.4 20.3
61.1
17.2
78.5
21.5
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Injuries Medical Diagnosis Behavioral Health
MH Group SA Group MH & SA No MH/SA
Highest Usage of ER: Visits for Highest Usage of ER: Visits for Medical Conditions per Thousand Medical Conditions per Thousand
Members by Group Members by Group
2425
688
1280 1267
2094
518864
1098
0
1000
2000
3000
4000
5000
No MH/SA Dx MH Dx SA Dx MH/SA Dx
Maine SC
ER Rates for Medical Dx Increase ER Rates for Medical Dx Increase with Complexity of Group Memberswith Complexity of Group Members
In both states, ER rates for medical In both states, ER rates for medical reasons, compared to group with no reasons, compared to group with no underlying behavioral health diagnoses underlying behavioral health diagnoses are:are:
1.9-1.7 times higher for MH group1.9-1.7 times higher for MH group
1.8-2.1 times higher for SA group1.8-2.1 times higher for SA group
3.5-4.0 times higher for the Co-occurring group.3.5-4.0 times higher for the Co-occurring group.
Second Highest Usage of ER: Injury Second Highest Usage of ER: Injury Visits per Thousand Members by Visits per Thousand Members by
Group for YearGroup for Year
680
188
299371
218178
431
970
200
400
600
800
1000
No MH/SA Dx MH Dx SA Dx MH/SA Dx
Maine SC
The Smallest Percentage of Overall The Smallest Percentage of Overall ER Usage is for Behavioral HealthER Usage is for Behavioral Health
Overall ---Overall --- 5.2% Maine ER visits are for MH5.2% Maine ER visits are for MH
3.3% South Carolina ER visits are for 3.3% South Carolina ER visits are for MHMH
Overall ---Overall --- 2.1% Maine ER visits are for SA2.1% Maine ER visits are for SA
1.0% South Carolina ER visits are for 1.0% South Carolina ER visits are for SASA
Conclusions of ER StudyConclusions of ER Study
Majority of ER visits are for injuries and Majority of ER visits are for injuries and medical conditions for all groupsmedical conditions for all groups
Rates of ER utilization for medical issues Rates of ER utilization for medical issues and injuries are increased in populations and injuries are increased in populations with behavioral disorderswith behavioral disorders
Effective care for these complex Effective care for these complex populations will depend on development populations will depend on development of integrated systems of care of integrated systems of care
Persons with Persons with Serious Mental IllnessSerious Mental Illness
Impact on physical health is same as Impact on physical health is same as for persons with any mental illness in for persons with any mental illness in the general population, only more sothe general population, only more so
Biggest Impediment to RecoveryBiggest Impediment to Recovery
Compared to the general population, Compared to the general population, persons with serious mental illness persons with serious mental illness on average lose 25 years of normal on average lose 25 years of normal life spanlife span
People are dying, not from their People are dying, not from their schizophrenia, but from chronic schizophrenia, but from chronic medical conditionsmedical conditions
For Persons with SMIFor Persons with SMI
Chronic Health Conditions Are anChronic Health Conditions Are an
Expectation Expectation
Not an ExceptionNot an Exception
High Rate of Health Disorders of Persons High Rate of Health Disorders of Persons with SMI Compared to Non-SMI Groups in with SMI Compared to Non-SMI Groups in
Maine Medicaid – 2004Maine Medicaid – 2004
59.4
28.6 28.421.7
17.411.5 11.1
22.8
5.96.3
33.9 30.0
0
10
20
30
40
50
60
70
80
Skeletal- Connective
Gastro-Intestinal
Obesity/Dyslipid
COPDInfectious Disease
Hypertension
Dental Disorders
Diabetes
Cancer
Heart Disease
Pneumonia/Influenza
Liver Disease
Per
cen
t M
emb
ers
SMI (N=9224)Non-SMI (N=7352)
Burden of Medical Illness: Burden of Medical Illness: Maine Medicaid 2004Maine Medicaid 2004
28%
46%
69%
27%
45%
69%
15%
27%
51%
0%
10%
20%
30%
40%
50%
60%
70%
80%
1 Plus Health Conditions 2 Plus Health Conditions 3 Plus Health Conditions
Pe
rce
nt
Me
mb
ers
SMISMI/SANon-SMI/SA
2929Bringing Health into Mental Bringing Health into Mental Health CareHealth Care
March 14-18, 2009March 14-18, 2009
Another Approach: BRFSS Questions Another Approach: BRFSS Questions Added to Consumer Satisfaction SurveyAdded to Consumer Satisfaction Survey
Height and Weight (translated into Body Mass Index)Height and Weight (translated into Body Mass Index)Have you ever been told by a doctor or health professional that Have you ever been told by a doctor or health professional that you have…(coronary artery disease, heart attack, diabetes, high you have…(coronary artery disease, heart attack, diabetes, high blood pressure, high cholesterol)?blood pressure, high cholesterol)?Do you smoke cigarettes?Do you smoke cigarettes?Now thinking about your physical health, which includes physical Now thinking about your physical health, which includes physical illness and injury, how many days during the past 30 days was illness and injury, how many days during the past 30 days was your physical health not good?your physical health not good?Now thinking about your mental health, which includes stress, Now thinking about your mental health, which includes stress, depression, and problems with emotions, how many days during depression, and problems with emotions, how many days during the past 30 days was your mental health not good?the past 30 days was your mental health not good?During the past 30 days, about how many days did poor physical During the past 30 days, about how many days did poor physical or mental health keep you from doing usual activities, such as or mental health keep you from doing usual activities, such as self-care, school, or recreation?self-care, school, or recreation?Would you say that your general health is…(excellent, very good, Would you say that your general health is…(excellent, very good, good, fair, poor)?good, fair, poor)?
3030Bringing Health into Mental Bringing Health into Mental Health CareHealth Care
March 14-18, 2009March 14-18, 2009
Health RiskHealth RiskMaine DIG Surveys Maine DIG Surveys (Age 18-64 Years)(Age 18-64 Years)
Health RiskHealth Risk Age GroupAge Group 2007 DIG Survey 2007 DIG Survey (n=731)(n=731)
2007 Maine2007 Maine BRFSSBRFSS
SmokingSmoking 18-4418-44
45-6445-64
46.1%46.1%
49.5%49.5%
26.3%26.3%
18.8%18.8%
ObesityObesity 18-4418-44
45-64 45-64
49.4%49.4%
49.6%49.6%
26.0%26.0%
27.6%27.6%
High CholesterolHigh Cholesterol 18-4418-44
45-6445-64
40.5%40.5%
38.6%38.6%
23.2%23.2%
46.0%46.0%
High Blood PressureHigh Blood Pressure 18-4418-44
45-6445-64
34.0%34.0%
34.7%34.7%
13.5%13.5%
34.0%34.0%
3131Bringing Health into Mental Bringing Health into Mental Health CareHealth Care
March 14-18, 2009March 14-18, 2009
Chronic Health ConditionsChronic Health ConditionsMaine DIG Surveys Maine DIG Surveys (Age 18-64 Years)(Age 18-64 Years)
** Cardiovascular Disease (CVD) = reported angina or heart ** Cardiovascular Disease (CVD) = reported angina or heart attackattack
Health RiskHealth Risk Age Age GroupGroup
2007 DIG 2007 DIG Survey Survey (n=731)(n=731)
2008 DIG 2008 DIG Survey Survey
(n=1190)(n=1190)
2007 2007 MaineMaine BRFSSBRFSS
Cardiovascular Cardiovascular Disease**Disease**
18-4418-44
45-64 45-64
11.3%11.3%
9.7%9.7%
5.3%5.3%
14.3%14.3%
1.3%1.3%
7.7%7.7%
DiabetesDiabetes 18-4418-44
45-6445-64
23.0%23.0%
25.5%25.5%
15.1%15.1%
29.2%29.2%
2.7%2.7%
9.4%9.4%
3232Bringing Health into Mental Bringing Health into Mental Health CareHealth Care
March 14-18. 2009March 14-18. 2009
Metabolic RiskMetabolic Risk
23.5
10.3
37.034.0
46.4
28.0
0.0
20.0
40.0
60.0
80.0
100.0
18-44 Age Group 45-64 Age Group
2 or More Risks Maine BRFSS
2 or More Risks 2007 DIG Survey (n=731)
2 or More Risks 2008 DIG Survey (n=1190)
Percent Reporting 2 or More Risks
Among persons with no diabetes: obesity, high blood pressure, Among persons with no diabetes: obesity, high blood pressure, or high cholesterolor high cholesterol
3333Bringing Health into Mental Bringing Health into Mental Health CareHealth Care
March 14-18, 2009March 14-18, 2009
Satisfaction Related to Physical Satisfaction Related to Physical Health StatusHealth Status
(…how many days during the past 30 days was your physical health not good?)(…how many days during the past 30 days was your physical health not good?)
Satisfaction Related to Physical Health Status
83.5
91.9
60.7
86.2
58.9
89.6
67.475.0
21.8
72.7
19.0
77.2
0.0
20.0
40.0
60.0
80.0
100.0
Perception ofAccess*
Perception of Qualityand
Appropriateness*
Perception ofOutcomes*
Participation inTreatmentPlanning*
Functioning* GeneralSatisfaction*
0 Physically Unhealthy Days 14 or More Physically Unhealthy Days
Percent Reporting
Costs to Maine MedicaidCosts to Maine Medicaid
Persons with co-morbid medical Persons with co-morbid medical and behavioral health disorders and behavioral health disorders
cost more both for medical and for cost more both for medical and for psychiatric servicespsychiatric services
Medical Expenditures for Persons Medical Expenditures for Persons with MH/SA Conditions Compared with MH/SA Conditions Compared
to General Maine Care 2002to General Maine Care 2002
MH/SA MH/SA Behavioral Behavioral ServicesServices
MH/SA MH/SA Medical Medical ServicesServices
General General MaineCareMaineCare
Medical Medical ServicesServices
$359 PUPM$359 PUPM
$422 PUPM$422 PUPM $163 PUPM$163 PUPM
Impact of Increasing Number of Medical Impact of Increasing Number of Medical Co-morbidities on Maine Mental Health Co-morbidities on Maine Mental Health Expenditures for Persons with Serious Expenditures for Persons with Serious
Mental IllnessMental Illness
$11,912.09
$18,781.63$20,650.39
$24,873.51
$0.00
$5,000.00
$10,000.00
$15,000.00
$20,000.00
$25,000.00
Avg MH Expenditures
0 1 2 3 or More
Summary of Integrated Analysis Summary of Integrated Analysis of Maine Dataof Maine Data
Mental ill health is associated with higher Mental ill health is associated with higher rates of chronic disease, poor outcome rates of chronic disease, poor outcome and higher medical costs in the general and higher medical costs in the general populationpopulation
Persons with Serious Mental Illness have Persons with Serious Mental Illness have even higher rates of health risk, chronic even higher rates of health risk, chronic disease, poor outcomes and higher costs disease, poor outcomes and higher costs
Bringing The Data to Key Bringing The Data to Key Policy DiscussionsPolicy Discussions
Governor’s OfficeGovernor’s OfficeCommissioner of DHHSCommissioner of DHHS
MedicaidMedicaidPublic HealthPublic HealthMental HealthMental Health
Maine State Health Plan:Maine State Health Plan:Support from the GovernorSupport from the Governor
Integration of mental health, public health Integration of mental health, public health and primary careand primary care
Ongoing surveillance of mental health Ongoing surveillance of mental health issues in health surveillanceissues in health surveillance
Person centered health care homePerson centered health care home
Health Info Net - interoperable electronic Health Info Net - interoperable electronic health information systems and a statewide health information systems and a statewide health information exchange systemhealth information exchange system
DHHS Policy ChangesDHHS Policy Changes
Integration of previously separate Integration of previously separate agencies into one state health and human agencies into one state health and human services agency, with an integrated services agency, with an integrated management structuremanagement structure
Commissioner’s Policy on Integrated Care Commissioner’s Policy on Integrated Care
DHHS Strategic Plan has as a focus DHHS Strategic Plan has as a focus integration of services to meet the integration of services to meet the complex needs of persons servedcomplex needs of persons served
The Maine Patient Centered The Maine Patient Centered Medical Home ProjectMedical Home Project
Includes behavioral health provider on Includes behavioral health provider on health care teamhealth care team
Care management to integrate medical Care management to integrate medical and behavioral health issuesand behavioral health issues
Patient self management support to Patient self management support to include both medical and behavioral include both medical and behavioral health issueshealth issues
Integration of Mental Health into Integration of Mental Health into Maine Medicaid InitiativesMaine Medicaid Initiatives
Financial support for Medical Home PilotFinancial support for Medical Home PilotNew policies for reimbursement of mental New policies for reimbursement of mental health providers in primary care settingshealth providers in primary care settingsMedicaid funded medical care Medicaid funded medical care management system routinely screens for management system routinely screens for depressiondepressionMedical care managers to coordinate with Medical care managers to coordinate with mental health case managers for persons mental health case managers for persons with SMIwith SMI
Integration of Mental Health into Integration of Mental Health into Maine Public Health InitiativesMaine Public Health Initiatives
Ongoing inclusion and integrated analysis Ongoing inclusion and integrated analysis of mental health modules in BRFSS will of mental health modules in BRFSS will permit county level and special population permit county level and special population data for local needs assessmentdata for local needs assessment
Universal Web Based Health Screen Universal Web Based Health Screen includes depression screening, education includes depression screening, education and treatment resourcesand treatment resources
Office of Adult Mental HealthOffice of Adult Mental Health
Ongoing inclusion of BRFSS health Ongoing inclusion of BRFSS health questions in DIG Consumer Satisfaction questions in DIG Consumer Satisfaction SurveySurveyInclusion of health questions in launch of Inclusion of health questions in launch of new Outcome Tool new Outcome Tool Partnerships with Medicaid, Elder Partnerships with Medicaid, Elder Services, Public Health to expand role of Services, Public Health to expand role of SMHA to include attention to mental SMHA to include attention to mental health of whole populationhealth of whole population
December 2008 – DHHS Partners December 2008 – DHHS Partners with Local Funder to Launch SMI with Local Funder to Launch SMI
Health ProjectHealth Project
Link every consumer with SMI to a Link every consumer with SMI to a welcoming medical home welcoming medical home Coordinate medical and mental health Coordinate medical and mental health care/case managementcare/case managementTrack health issues in mental health Track health issues in mental health system workflowsystem workflowDevelop consumer led health Develop consumer led health programmingprogramming
Maine SMI Health Project Will…Maine SMI Health Project Will…
Develop information sharing systems Develop information sharing systems between consumers, mental health and between consumers, mental health and health care systemshealth care systemsEducate workforce/consumers: health Educate workforce/consumers: health literacy, health advocacy, chronic disease literacy, health advocacy, chronic disease care, self managementcare, self managementInform development of policy, contracts, Inform development of policy, contracts, regulation and system design at the state regulation and system design at the state level level
Integration: Integration: Making the Case in MaineMaking the Case in Maine
Surveillance and data gathering are key Surveillance and data gathering are key first stepsfirst steps
Maine specific data is necessary to drive Maine specific data is necessary to drive policy, programming and quality policy, programming and quality improvementimprovement
Analyses concurrently addresses physical Analyses concurrently addresses physical and behavioral health issuesand behavioral health issues
Dissemination is a Critical Dissemination is a Critical Part of SurveillancePart of Surveillance
Present , present, present Present , present, present
to many different audiences (not to many different audiences (not just a report that sits on a shelf)just a report that sits on a shelf)
Dissemination Strategies: Dissemination Strategies: ONE SIZE ONE SIZE REPORTING ONLY USEFUL TO ONE REPORTING ONLY USEFUL TO ONE
SIZE STAKEHOLDERSIZE STAKEHOLDERTailor presentation to each audience, showing howTailor presentation to each audience, showing howattention to integration is attention to integration is not an add onnot an add on but will but willserve their specific aimsserve their specific aims
MH audience – how chronic disease impacts MH audience – how chronic disease impacts RecoveryRecoveryHealth audience –impact of mental illness on Health audience –impact of mental illness on chronic disease and population healthchronic disease and population healthLegislature – impact of siloed approach on total Legislature – impact of siloed approach on total costs of carecosts of care
Tie Data and Dissemination Tie Data and Dissemination to State Program and Policy to State Program and Policy
IssuesIssues
Give non mental health partners Give non mental health partners concrete suggestions for what they can concrete suggestions for what they can do to integrate mental health into their do to integrate mental health into their
regular programmingregular programming
Implications for Health Policy for Implications for Health Policy for General PopulationGeneral Population
Many forms of mental illness are highly Many forms of mental illness are highly prevalent, under-recognized, less disabling than prevalent, under-recognized, less disabling than SMI but associated with poor healthSMI but associated with poor healthOverall health depends on addressing both Overall health depends on addressing both mental health and physical health in an mental health and physical health in an integrated fashionintegrated fashionPublicly funded health systems should Publicly funded health systems should addresses mental illness in the general addresses mental illness in the general populationpopulationStart with depression Start with depression
Implications for MedicaidImplications for Medicaid
Medicaid/SMHA populations have high Medicaid/SMHA populations have high degree of complexity. Needs span degree of complexity. Needs span multiple traditional service sectors. multiple traditional service sectors. Need for integrated approach.Need for integrated approach.
Integration needed at all levels of the Integration needed at all levels of the public system: surveillance, public system: surveillance, reimbursement, programming, reimbursement, programming, workforce trainingworkforce training
Implications for MedicaidImplications for Medicaid
Support screening and integrated treatment Support screening and integrated treatment of depression in traditional health care of depression in traditional health care settings settings
Support screening and treatment of health Support screening and treatment of health conditions among persons treated by conditions among persons treated by specialty mental healthspecialty mental health
Implications for Public HealthImplications for Public Health
Support ongoing inclusion of MH Support ongoing inclusion of MH modules in BRFSS modules in BRFSS
Develop depression screening and Develop depression screening and awareness tools linked to health risk awareness tools linked to health risk and chronic disease programmingand chronic disease programming
Include mental health objectives in Include mental health objectives in Healthy Maine 2020Healthy Maine 2020
Implications for SMHAImplications for SMHA
Expand programming to SMI population to Expand programming to SMI population to include attention to health and wellnessinclude attention to health and wellness
Expand role of SMHA to include persons Expand role of SMHA to include persons with less disabling forms of Mental Illnesswith less disabling forms of Mental Illness
Partner with state Public Health and Partner with state Public Health and Medicaid to support integration of mental Medicaid to support integration of mental health into health policy and programminghealth into health policy and programming
Attending to health and wellness for Attending to health and wellness for persons with SMIpersons with SMI
Start with surveillance – if you don’t measure it, Start with surveillance – if you don’t measure it, you won’t manage ityou won’t manage it
Keep it simple – History of smoking, alcohol use, Keep it simple – History of smoking, alcohol use, major chronic diseasesmajor chronic diseases
Track BMI, Blood Pressure, glucose and lipidsTrack BMI, Blood Pressure, glucose and lipids
Integrate health surveillance into current Integrate health surveillance into current activities: ISP development, med management, activities: ISP development, med management, consumer survey, outcome measuresconsumer survey, outcome measures
Elsie Freeman, MD, MPHMedical Director, Behavioral HealthDHHS Office of Quality Improvement ServicesE-mail: [email protected]
Jay Yoe, PhDDirectorDHHS Office of Quality Improvement ServicesE-mail: [email protected]