The Interdependence of Mental Health and Physical Health The case for creating integrated systems of care James Yoe PhD; Elsie Freeman MD Maine Department.

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]