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Healthiest Wisconsin 2010 Status Report to the Public Health Council State Health Plan Committee

Healthiest Wisconsin 2010 Status Report to the Public Health Council State Health Plan Committee. (October 18, 2007) Mental Health and Mental Disorders Bureau of Mental Health and Substance Abuse Services Division of Mental Health & Substance Abuse Services

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Healthiest Wisconsin 2010 Status Report to the Public Health Council State Health Plan Committee

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  1. Healthiest Wisconsin 2010Status Report to the Public Health Council State Health Plan Committee (October 18, 2007) Mental Health and Mental Disorders Bureau of Mental Health and Substance Abuse Services Division of Mental Health & Substance Abuse Services Wisconsin Department of Health & Family Services

  2. Presentation Outline • Introduction to policy recommendations and MH HW2010 objectives • Overview of mental health in Wisconsin • Prevalence • Unmet need for treatment • Social and economic factors • Disparities • Outcomes • Expenditures • Mental health HW2010 objectives • past efforts, current status, and future efforts • Discussion of recommendations HW2010 MH presentation 10-18-2007

  3. Overview - Mental Health Policy/ Programmatic Recommendations • Enact insurance parityto combat financial barriers to access to MH care. • Implement screening for depression, substance abuse, and trauma in primary care. • Reduce health disparities for MH consumers in both primary and MH care. • Promote effective MH treatment. • Combat stigma through education with targeted audiences. HW2010 MH presentation 10-18-2007

  4. Overview of MH HW2010 Objectives • Increase mental health screening and referral • Increase cultural competence of services provided to MH consumers • Decrease stigma • Increase access to care through the use of evidence-based practices HW2010 MH presentation 10-18-2007

  5. Data Sources and Limitations • National Surveys on Drug Use and Health (NSDUH) • Brief module used to define MH needs • Behavioral Risk Factor Surveillance Survey (BRFSS) • Phone survey that excludes cell phone users • National Comorbidity Study (NCS) • Youth Risk Behavior Survey (YRBS) • Only children in grades 9-12 included • Human Services Reporting System (HSRS) • Variable quality and completeness • MH/AODA Functional Screen • Adults with a serious mental illness (SMI) and for limited programs • Mental Health Statistical Improvement Project’s (MHSIP) Satisfaction Survey • Wisconsin United for Mental Health (WUMH) stigma surveys • State administrative data (expenditures, etc.) HW2010 MH presentation 10-18-2007

  6. Prevalence of Mental Health Needs for Adults • 11.8% (486,079) of Wisconsin adults aged 18+ experienced serious pyschological distress (SPD) in the past year compared to the 11.6% national average (NSDUH, 2004-05). • Wisconsin’s SPD national rank is 25th. • 8.4% (346,022) of Wisconsin adults aged 18+ experienced a major depressive episode (MDE) in the past year compared to the 7.6% national average (NSDUH, 2004-05). • Wisconsin’s MDE national rank is 35th. HW2010 MH presentation 10-18-2007

  7. U.S. Prevalence of Serious Psychological Distress in Adults 18+ (NSDUH 2005) HW2010 MH presentation 10-18-2007

  8. U.S. Prevalence of Major Depressive Episode in Adults 18+ (NSDUH 2005) HW2010 MH presentation 10-18-2007

  9. Prevalence of Depression in Youth • 9.4% of Wisconsin youth aged 12-17 experienced a major depressive episode (MDE) in the past year compared to the 8.8% national average (NSDUH, 2004-05). • Wisconsin’s MDE national rank is 11th. • 28.5% of students nationwide experienced periods of depression that limited their functioning in 2005 compared to 27.6% in Wisconsin (YRBSS) • The 2005 youth depression rate (YRBSS) in Wisconsin increased from 25.3% in 2003. • The female youth depression rate was 33.3% in 2005 compared to 22.2% for males. HW2010 MH presentation 10-18-2007

  10. U.S. Prevalence of Major Depressive Episode in Youth (NSDUH 2005) HW2010 MH presentation 10-18-2007

  11. Prevalence of Suicide Among Youth • Wisconsin ranks 8th in youth suicides in the U.S. • Average WI suicide rate from 1999-2003 for 15-19 yr. olds was 10.9/100,000. (IA-10.6, MN-9.4, IN-8.3, MI-7.8, IL-6.1). HW2010 MH presentation 10-18-2007

  12. Prevalence of Co-occurring Disorders – U.S. (NSDUH 2005) • In 2005, adults who used illicit drugs in the past year were significantly more likely to have SPD compared with adults who did not use an illicit drug (22.0 vs. 9.6 percent). • Past year illicit drug use was higher among adults with SPD (26.9 percent) than among adults without SPD (12.1 percent). • Similarly, the rate of past month cigarette use was higher among adults with SPD (42.8 percent) than among adults without SPD (24.5 percent). • Among adults with SPD in 2005, 21.3 percent (5.2 million) were dependent on or abused illicit drugs or alcohol. The rate among adults without SPD was 7.7 percent (14.9 million). HW2010 MH presentation 10-18-2007

  13. Prevalence of Co-occurring Disorders (Wisconsin, 2004-05) • The MH/AODA Functional Screen is a Wisconsin-based screen that measures level of need within Wisconsin’s major programs for mental health consumers with a serious mental illness (SMI). • Community Support Programs (CSP) • Comprehensive Community Services (CCS) • Of 3,357 consumers screened in 2004-05, 70.4% had a co-occurring physical health diagnosis and 25.8% had a co-occurring substance abuse diagnosis. 17.9% had co-occurring MH/SA/physical health diagnoses. • 21.6% had a MH diagnosis only. • Consumers with co-occurring MH/SA diagnoses had higher than average rates of inpatient stays, CJ system involvement, suicide attempts, and homelessness in their history. HW2010 MH presentation 10-18-2007

  14. Mental Health Consumers Served • The number of persons served statewide in the public mental health system in 2005 was approximately 196,634. • Public service recipients are reported to the State through the HSRS and Medicaid (MA) data systems which include some duplication of clients. • Clients served in the private sector are not reported here. HW2010 MH presentation 10-18-2007

  15. Unmet Need for Treatment (NSDUH) Reasons for Not Getting Treatment or Counseling* for Mental Health Problems in the Past Year among Adults Aged 18 or Older Who Perceived an Unmet Need for Treatment for Mental Health Problems in U.S.: 2003, 2004, and 2005 HW2010 MH presentation 10-18-2007

  16. Social and Economic Factors HW2010 MH presentation 10-18-2007

  17. Social and Economic Factors HW2010 MH presentation 10-18-2007

  18. Social and Economic Factors - Trauma • Approximately 8% of individuals in the U.S. – 20 million people – will be diagnosed with PTSD in their lifetime. (NTAC lit. review, 2004) • "The more adverse childhood experiences reported, the more likely the person is to have heart disease, cancer, stroke, diabetes, skeletal fractures, liver disease, and poor self-rated health as an adult.“ (CDC, 1998) • Up to 81% psychiatric hospital clients diagnosed with a major mental illness have experienced physical or sexual abuse. (NTAC lit. review, 2004) • Women molested as children are at 4 times greater risk for major depression than those with no such history. (NTAC lit. review, 2004) • More than 66% of homeless mothers have experienced severe physical violence and 43% were sexually molested during childhood. (NTAC lit. review, 2004) • Up to two-thirds of individuals entering substance abuse treatment suffer from PTSD, or posttraumatic stress symptoms. (NTAC lit. review, 2004) HW2010 MH presentation 10-18-2007

  19. Outcomes for MH Consumers • 28% of adult MH service recipients with a SMI were employed, 40% were unemployed, and 32% were not in the labor force (HSRS, 2005). • 7% of adult MH service recipients with a SMI were arrested in the past year (MHSIP, 2006). • 20% of youth MH service recipients with a SED were arrested in the past year (MHSIP, 2006). • Studies have shown that people with mental illnesses have a 20% loss in life expectancy (Anxiety, Addiction, and Depression Treatments, Jan. 2007). HW2010 MH presentation 10-18-2007

  20. State Mental Health Expenditures* (Equitable, Adequate, and Stable Financing) *Federal portion of Medicaid not included. Data reported through the HSRS. HW2010 MH presentation 10-18-2007

  21. HW2010 Mental Health Objective: Increase Access to Care with EBP’s • “By 2010, Wisconsin's public mental health clients who have access to evidence-based mental health treatments will increase by 10 percent.” Status: Improving. Notes: Need to monitor evidence-based practice (EBP) use and implementation fidelity. HW2010 MH presentation 10-18-2007

  22. Efforts to Increase the Use of EBP’s • Assertive Community Treatment (ACT) recognized federally and nationally as an EBP – called Community Support Programs (CSPs) in Wisconsin • CSP is a Medicaid-reimbursable service matched with county funds • 64 counties in Wisconsin currently operate 80 certified CSPs; State funds offered annually to help new counties become CSP-certified • Although based on ACT model, fidelity with which CSP is implemented is known to be variable; BMHSAS resources to monitor fidelity and provide TA are minimal. HW2010 MH presentation 10-18-2007

  23. HW2010 MH presentation 10-18-2007

  24. Efforts to Increase the Use of EBPs for Consumers with a SMI • Grants to counties to implement EBPs and quality improvement systems (3 in 2006, 5 in 2007). • Integrated Dual Diagnosis Treatment (IDDT) and Motivational Interviewing – 3 counties in 2007. • Illness Management and Recovery (IMR) – 2 counties in 2007. • National Alliance for Mental Illness (NAMI) – WI beginning Family Psychoeducation in 2008. • DVR implemented three Supported Employment programs from 2005-07. • 2006 Bureau Conference provided training on implementation of IDDT and other EBPs. • Bureau work group currently establishing EBP training resources for providers. HW2010 MH presentation 10-18-2007

  25. Tracking Consumers Served with EBPs • Training for IMR and Family Psychoeducation provided in 2006-07; first consumers to be served in 2007. HW2010 MH presentation 10-18-2007

  26. HW2010 Mental Health Objective: Increase Access to Care with EBP’s • “By 2010, Wisconsin's public mental health clients who have access to best practice mental health treatments will increase by 10 percent.” Status: Improving Notes: Need further work to define best practices vs. EBPs and monitor their use and implementation fidelity HW2010 MH presentation 10-18-2007

  27. Efforts to Increase the Use of Best Practices • Psychosocial Rehabilitation is a federally-recognized Medicaid benefit – called Comprehensive Community Services (CCS) in Wisconsin • Children’s system of care wraparound programs – Integrated Service Projects (ISPs) and Coordinated Service Teams (CSTs) • 36 counties with ISP/CSTs in 2007 • Milwaukee Wraparound and Dane CCF managed care programs HW2010 MH presentation 10-18-2007

  28. HW2010 MH presentation 10-18-2007

  29. Tracking Consumers Served with Best Practices • * Due to missing data, numbers served for 10 of the ISP/CSTs projected based on 2005 data. HW2010 MH presentation 10-18-2007

  30. HW2010 Mental Health Objective 2: Increase Cultural Competence • “By 2010, 87 percent of publicly-funded mental health consumers will feel their service provider was sensitive to their culture during the treatment planning and delivery process.“ Status: Improving with concerns Notes: Need more representative data and need more targeted programmatic efforts and initiatives HW2010 MH presentation 10-18-2007

  31. Efforts to Eliminate Health Disparities • Development of CSTs for Native American tribes. • Targeted grant funding for tribal system development to improve services for consumers with co-occurring disorders. • 2006 focus groups on identifying Milwaukee children’s MH needs. • DHH MH interpreter training. • DHH crisis and emergency preparedness work. • Report on Women and Depression. • Telehealth is available through the Marshfield Clinic and a few other rural locations. DHFS has provided funding and certification. HW2010 MH presentation 10-18-2007

  32. MHSIP Survey Indicator for Cultural Competence 2003-2006 • Question = “Staff were sensitive to my cultural background (race, • religion, language, etc.).” • Indicator = Number of clients who “Strongly Agree” or “Agree” on a • 5-point scale. HW2010 MH presentation 10-18-2007

  33. Elimination of Health Disparities: Mental Health Prevalence by Racial and Ethnic Background HW2010 MH presentation 10-18-2007

  34. HW2010 Mental Health Objective:Decrease Mental Health Stigma • “By 2010, an additional 15 percent of the general public will demonstrate an understanding that individuals with mental health disorders can recover through treatment to lead productive, healthy, and happy lives.” • “By 2010, an additional 15 percent of the general public will demonstrate the belief that individuals with mental health disorders are capable of sustaining long-term productive employment.” Status: Improving, but slowly Notes: Challenging task to impact statewide attitudes, but current initiatives are making an impact HW2010 MH presentation 10-18-2007

  35. Efforts to Decrease Mental Health Stigma • Within the general public, misunderstandings exist about the scientific knowledge regarding mental illness, treatment outcomes, dangerousness of persons with mental illness, and recovery. • A new MH module of the 2007 BRFSS will provide data on MH stigma to help monitor progress. • Lt. Gov. Barbara Lawton is Honorary Chair of WUMH Board and leads the Implementation Committee for the Report on Women and Depression (May, 2006). • NAMI Consumer Council tailoring website on Recovery including stigma information. • Support Grassroots Empowerment Project (GEP) - a statewide consumer-driven advocacy organization. • Mental Health Coalition of Greater La Crosse Area, Milwaukee Mental Health Task Force on Mental Health, Green Bay Mental Health Task Force for Children, Chippewa’s Children’s Mental Health all formed since 2004. HW2010 MH presentation 10-18-2007

  36. Decreasing Stigma:Wisconsin United for Mental Health • WI United for Mental Health with a mission to advocate for the elimination of stigma associated with mental illness and public education about the barriers to recovery and treatment. • Business leaders, human service workers, educators, media, and others were invited to mental health stigma awareness workshops. • Surveys conducted before stigma awareness session, post-session, and 3-month follow-up survey. HW2010 MH presentation 10-18-2007

  37. Stigma Workshops Impact (Appleton and Green Bay) HW2010 MH presentation 10-18-2007

  38. HW2010 Mental Health Objective:Increase Screening and Referral • By 2010, 80 percent of State-administered employee group health plans, Medicaid-funded programs, BadgerCare, and SSI managed care will, by contract, incorporate questions for mental health problems into their screening and referral processes. Status: Variable and slow. Notes: Focus to date has been on managed care programs. HW2010 MH presentation 10-18-2007

  39. Efforts to Increase MH Screening and Referral (Coordination of State and Local Partnerships) • Promoting Mental Health Awareness Month activities and Depression screening days. • Mental Health America-Wisconsin efforts • Held summits in 2005 & 2006 on screening in conjunction with Primary Care Physicians. Another planned for Nov. 2007. • Wisconsin Medical Journal publication on MH • Expanded use of Problem Oriented Screening Instrument for Teenagers (POSIT) to identify children in the Juvenile Justice system with MH/SA needs to 29 counties. • Identifying best practice tools and promoting the screening and treatment of MH/SA issues for consumers receiving Medicaid fee-for-service and Badger Care HMO services. • Badger Care Plus will be screening pregnant women for MH, SA, PTSD, and tobacco use problems. • Pilots in 10 counties to screen for MH/SA needs for children in the child welfare system. HW2010 MH presentation 10-18-2007

  40. Coordination of State and Local Partnerships Joint statement between Mental Health, Substance Abuse, and Public Health: “We aspire to become a society that optimizes the mental, physical, social, emotional, and spiritual health of all persons. Prevention, screening, intervention, and treatment will be person and family-centered, accessible, and appropriate to the culture and language of the individuals. These principles build resiliency, facilitate recovery, and eliminate stigma.” HW2010 MH presentation 10-18-2007

  41. Key Partners • County Human Services • Public Health • Health Care Providers and Systems • DHFS, Pathways to Independence • UW-Universities and Technical College System • Wisconsin United for Mental Health • Lt. Governor Barbara Lawton • DPI and Local School Systems • Department of Workforce Development: Disability Program Navigators and Bureau of Migrant, Refugee, and Labor Services • Psychologists • Substance Use Providers • Physicians and Provider Associations • Wisconsin Council on Mental Health • Consumer, Family & Advocacy Organizations • Faith-Based Communities • Suicide Prevention Intervention (SPI), Crisis Response Network • Tribal Organizations incl. Great Lakes Inter-Tribal Council, Inc. • SAMHSA, ADS Center, and partner organizations HW2010 MH presentation 10-18-2007

  42. Local Public Health Department Priorities HW2010 MH presentation 10-18-2007

  43. Local Public Health Department Priorities HW2010 MH presentation 10-18-2007

  44. Primary Issues in the Mental Health System • Access to services • Financial, geographical, cultural • Need for integrated services • Work force training/education • Use of best available practices • Lack of identification of MH needs across all health fields HW2010 MH presentation 10-18-2007

  45. Mental Health Policy/ Programmatic Recommendations (Equitable, Adequate, and Stable Financing) • Enact insurance parityto combat financial barriers to access to MH care • Lack of parity not only prevents initial access to MH care, but also prevents access to adequate amounts of MH care. • Wisconsin is one of 9 states without some form of mental health and substance abuse (MH/SA) health insurance parity legislation. • 41 other states have some form of legislation providing MH/SA coverage that is more comparable to coverage for other medical conditions. • Continued growth of Medicaid managed care programs. HW2010 MH presentation 10-18-2007

  46. Mental Health Policy/ Programmatic Recommendations • Implement screening for depression, substance abuse, and trauma in primary care • MH/SA, suicide risk screening and early identification integrated into primary health care systems (Include protocols and tracking of screening, outcomes, and client data). • Provide models of successful MH referral and access systems within primary care to mentor and provide consultation to others. • Offer MH protocols and models for referral, so that physicians/staff have services (place) to send patients with MH/SA needs. HW2010 MH presentation 10-18-2007

  47. Mental Health Policy/ Programmatic Recommendations (Elimination of Health Disparities) • Reduce health disparitiesfor MH consumers in both primary and MH care. • Promote integrated and co-located MH services within primary care clinics. • Provide training/education for MH/primary care providers on delivery of culturally competent MH services. • Increase access to MH services for pregnant and postpartum women • Incorporate/monitor data from the Pregnancy Risk Assessment Monitoring System (PRAMS) a CDC grant, incorporating depression into a self-report survey (150 women/per month for 3 and a half years). • Increase depression screening postpartum into health care systems (i.e., Racine-All Saints Hospital, Unity Health Care, and Marshfield Clinic). HW2010 MH presentation 10-18-2007

  48. Mental Health Policy/ Programmatic Recommendations • Promote effective MH treatment • Only 33% of people with a psychiatric disorder were treated adequately and only 13% of those who saw general medical practitioners were treated adequately (NCS, 2001-03). • Need to facilitate the dissemination of evidence-based practices on a statewide basis by making implementation materials accessible • Need to increase the availability of training for clinicians and supervisors on the use of specific EBP’s • Need to track statewide EBP efforts and facilitate a “learning collaborative” approach in which counties will learn from each others EBP implementation experiences • Special certification and MA rates would provide incentives for providers to use EBP’s HW2010 MH presentation 10-18-2007

  49. Mental Health Policy/ Programmatic Recommendations • Combat stigma through health care and other professional education • Efforts to decrease stigma will impact people seeking treatment earlier, thus improving MH outcomes for recovery, lessens severity and duration of the disorder; may prevent need for crisis intervention, and/or ER presentation • Education and awareness to MH/MI screening across medical disciplines for early identification of risk factors and referral to treatment services and supports • Professional education about stigma and their own personal biases toward MI and persons who have MI, recovery, and person/family-centered non-stigmatizing treatment and work environments HW2010 MH presentation 10-18-2007

  50. Healthiest Wisconsin 2010Status Report to the Public Health Council State Health Plan Committee Joyce Allen Bureau Director Bureau of Mental Health and Substance Abuse Services (266-1351; allenjb@dhfs.state.wi.us) Rebecca Cohen Planner/Analyst Bureau of Mental Health and Substance Abuse Services (266-2712; cohenrw@dhfs.state.wi.us) Tim Connor Researcher University of Wisconsin Population Health Institute (261-6744; connotg@dhfs.state.wi.us) HW2010 MH presentation 10-18-2007

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