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Behavioral Health in Health Care Reform: Why and How?. Mike Hogan, Ph.D. Commissioner, NYS Office of MH Chair, Pres. NFC on Mental Health (2002-3). Behavioral Health in Health Care Reform: Why and How?. Why?: Mental health problems are a major concern in every health care sector:
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Behavioral Health in Health Care Reform:Why and How? Mike Hogan, Ph.D. Commissioner, NYS Office of MH Chair, Pres. NFC on Mental Health (2002-3)
Behavioral Health in Health Care Reform:Why and How? • Why?: • Mental health problems are a major concern in every health care sector: • Mental health problems of children are the #1 kids’ health problem and shape physical health later in life • Mental health problems are frequent in adults, and patients with mental illness present in every primary care, acute care, and chronic illness setting • We have good evidence about integrating care, but we don’t do it • Where is Integration Needed? • What does Integration Require?
Behavioral Care is now an Essential Element of Child Health Care— Especially for Children at Risk • Child mental health problems: • Are the most prevalent and costly health conditions for children; “the major chronic diseases of childhood” • Childhood is when mental health problems emerge—and when preventive e.g. non-pharmacologic treatments are often effective • Effective interventions exist but are scattered “oases” • Nurse-Family Partnership • Other intensive parent education/support programs: Positive Parenting Program (PPP), Incredible Years, ParentCorps • Addressing child mental health problems prevents adult chronic illness!
The Adverse Childhood Experiences (ACE) Study (www.acestudy.org) • Adverse Childhood Experiences* (ACEs) are very common • ACEs are strong predictors of laterhealth risks and disease • This combination makes ACEs ‘the leading determinant of the health and social well-being of our nation’ * Psychological or physical abuse by parents; Sexual abuse; Household Dysfunction: Substance Abuse, Mental Illness, Mother Treated Violently, Imprisoned Household Member
Early Early Death Death Disease, Disability Adoption of Health-risk Behaviors Social, Emotional, & Cognitive Impairment Adverse Childhood Experiences Adverse Childhood Experiences The Influence of AdverseChildhood Experiences Throughout Life
Behavioral Health Care is Integral in Health Care for Adults • In acute medical care settings: • 35% comorbidity of depression and other illnesses in pts with acute physical illness • Typically 30-40% increase in inpatient stay • Complications on discharge if not addressed • Chronic illness care • Prevalence of depression alone: 30%+ • For patients with serious condition e.g. major depression: managing the mental illness is a prerequisite to successful chronic illness care • Integration is the Exception, not the Rule
Integrated Care Requires more than Parity: Mental Health Trends 1--Good news, but what happened? 2--Trends Since 2002: % with depression, adequate care: -2002: 36.9% -2003: 33.3% -2004: 31.7% (Harmon et al., 2009) Source: National Comorbidity Study and NCS-R (Kessler et al.)
Integration of General and Behavioral Health Must be 2-Way: Massachusetts Study: Deaths from Heart Disease Among People with SMI vs. Overall 1998-2000 2.2RR 1.5RR 4.9RR 3.5 RR
What Does it Take for Adequate MH Care in Health Settings—and Vice Versa? Recommendations • Parity is necessary, but insufficient • Screening is necessary for detection • E.g. Preventive Services Task Force Recommendations • In office based primary care, many practices can handle “simple” mental illness (mild depression, ADHD)…but • In high volume and complex care settings, adequate assessment and care require a mental health professional “on the floor” (e.g. “depression nurse”) • Similarly, in behavioral health settings, many practices can handle basic health care • Measures of care (e.g. detection rates, provision of care meeting standards) are essential