Integration of Physical and Behavioral Health

1. Integration of Physical and Behavioral Health NAMI Maine March 2011 Rockland, Maine

2. Issues • People with mental illness and their families are often isolated and don’t know where to get help and their health and recovery suffer. • People with mental illness die 25 years sooner than their peers who do not have mental illness • The medical and behavioral health systems are virtually closed during evenings and weekends.

3. Issues • Persistent stigma, fear, and lack of understanding contribute to “siloed” approach to treatment. • History of poor treatment based in stigma contributes to reluctance in peer and family community to disclose.

4. Everyone Needs to Change • The medical community must integrate behavioral health. • The behavioral health community must integrate physical health. • The advocacy – peer and family support community must promote integrated care. • Integrated must be defined as including peer and family supports.

5. Peer and Natural Supports • Primary care and mental health providers often do not understand the value and evidence base of peer and family supports, preventing people who need these kinds of supports from finding them. • NAMI Maine has engaged in a two-year effort to demonstrate the value and promote the use of peer and family supports.

6. Multisite findings • Judith Cook conducted multi-site research which suggests that when consumer operated service programs are integrated within a continuum of care, they enhance opportunities for consumers of mental health services to live, work, learn, and participate fully in the community.

7. Institute of Medicine • 2006 Crossing the Quality Chasm Report: Improving the Quality of Health Care for Mental and Substance-use Conditions: • Recommendation 3-1: To promote patient-centered care, all parties involved in health care for mental or substance use conditions should support the decision-making abilities and preferences for treatment and recovery of persons with M/SU problems and illnesses.

8. 2008 Review • A 2008 review of effectiveness studies concludes the outcomes of mutual help groups, measured by improvement in psychological and social functioning were equivalent to those of substantially more costly professional interventions.

9. Three Integration Projects • AFPS: “Advancing Family and Peer Supports” – produce a report detailing the research AND prove that Maine’s supports are valid. 2. Integration in Primary Care – Help 3 primary care practices embed support groups and expand access to psychiatry.

10. Three projects continued 3. Integration into behavioral health. Help 2 behavioral health centers expand their attention to the physical needs of their clients AND embed peer and family supports into their programs.

11. Implementing the 3 projects • NAMI Maine – The report making the case – AFPS • The Maine Primary Care Association – embedding into primary care offices • The Co-Occurring Collaborative Serving Maine - CCSME

12. Findings • Maine’s peer and family support programs are siloed – from each other and from providers. • Maine’s peer and family support programs help prevent the use of higher cost services like emergency rooms, hotlines, and hospitals. • Maine’s peer and family support programs cost significantly less than formal treatments and enhance recovery.

13. Findings Continued • Maine’s peer and family programs meet national fidelity standards, though improvements can be made. • On average people participate daily and for 5-8 years.

14. PROJECTS 2 AND 3 • If you ask others to integrate, YOU have to integrate. • Revised affiliate toolkit to stress addressing the physical health needs of participants (inviting speakers on smoking cessation, TBI, diabetes, substance abuse; • Revised handouts about support groups to include AA and NA, diabetes support, TBI, Alzheimer's, Autism, etc)

15. Behavioral Health Centers • One center added blood pressure monitoring, exercise classes, and improved attention to diet to their residential programs. • Both center’s added waiting room information about peer and family supports. • One center intended to enhance its relationship with the local health care center.

16. Perspective of Behavioral Health • Barriers: • Different beliefs across physical health, mental health, substance abuse and family and peer support services • Siloed systems • Lack of communication, knowledge, defined roles, policies, payment codes, payment allowances

17. Perspective of Behavioral Health • Next Steps Needed • Build commitment to new values and beliefs - transformational • Engage all levels of the organization & participants • Address conflict • Define an architecture for change • Identify champions & linkages • Create infrastructure, define roles

18. Primary Care Centers • Three centers – three reactions • You’ve seen one, you’ve seen one.

19. Three Primary Care Centers • Focus on Children: offered training for parents; placed additional information in waiting room. • Focus on Peer Supports: surveyed patients, embedded peer support group, on-going group and local educational sessions. • Deferred to integrated site; stigma in non-integrated site prevented further action.

20. What we learned • Many places may be interested, but… • Integrating behavioral and physical health care is harder than you think it will be because of: Lack of expertise Lack of funding Lack of Time Stigma No real interest Internal nay sayers Lack of internal structure Not willing/no one to do the work Readiness to change

21. What we Learned from the Pilots • There is confusion about what peer supports are – even in behavioral health community. • There is anxiety about embedding peer supports – stigma related. • It takes longer than you think it will. • To make it happen you need (l) and internal champion, (2) changes in policy (3) a firm commitment to implement and enforce policy, (4) persistence..

22. Integrated, Holistic Approaches