NHMH - NO HEALTH WITHOUT MENTAL HEALTH
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NHMH NO HEALTH WITHOUT MENTAL HEALTH A 501(c)(3) non profit   San Francisco - Washington DC Director’s blog

CASE MANAGEMENT SOCIETY OF AMERICA INTERVIEWS NHMH. THE CMSA IS THE LEADING ORGANIZATION DEDICATED TO THE PROFESSIONAL NATIONAL

Published Monday 29 of September, 2014


BY CHERI LATTIMER, RN, BSN, EXECUTIVE DIRECTOR, CMSA


In June I had the opportunity to spend time with Florence Fee, executive director for No Health Without Mental Health (NHMH). I was impressed with Florence’s commitment and passion about changing the stigma surrounding mental health; her perspective on integrated care and case management; as well as the work NHMH is doing to address the critical issues of coordinating care for the medically complex patient, including the seriously mentally ill with multiple morbidities, and their family caregivers.


NHMH (www.nhmh.org) is a start-up patient advocacy non-profit formed in 2007 in the San Francisco Bay Area, with a branch opened in Washington, D.C. in 2011. Its mission is to create a new social norm where the term “health” is broadly accepted to include mental health and physical health, completely, equally, and seamlessly, with no lingering shame regarding mental disorders. NHMH believes routine integrated medical-behavioral care delivery will be vital care delivery. It will not only improve the quality of total health care but also contribute to eliminating the social stigma that surrounds mental disorders. NHMH defines integrated care as the treatment of both physical health conditions and mental health conditions in a comprehensive, coordinated way, where both the patient’s physical and mental health practitioners work together, and are in active, regular communication, over all the patient’s conditions.


Mental health is relevant to *everyone due to the widespread interactions between medical conditions and mental disorders over the course of a lifetime.*


NHMH has committed to five key beliefs and values:


  1. That true overall health and well-being is made up of both mental health and physical health.
  2. That mental health is relevant to everyone since, over the course of a lifetime, we are all vulnerable to the many and widespread interactions between medical conditions and mental disorders.
  3. That re-perceiving “health” for all of us will allow many people to seek available treatment for mental health problems — people who may now avoid treatment due to the stigma surrounding mental illness.
  4. That early detection of mental disorders, intervention to preempt or prevent chronic disability, treatment, and recovery wherever possible, leads to fuller and more productive lives.
  5. That all of us must take responsibility for our health, mental health, and physical health, and seek treatment when needed.


NHMH understands the struggle and hardship patients and family caregivers encounter in managing their physical and mental health issues within the fragmentation of our current health care delivery system. I spent time understanding the mission and vision of NHMH and then asked Florence for an interview to get her insight and opinion of where we are today in bringing greater awareness and education to the public about mental health; providing better integrated care, care coordination and case management; as well as what efforts are underway in developing public policy awareness and support.



Q&A WITH FLORENCE FEE AND CHERI LATTIMER


CL: HOW FAR DO YOU THINK THE U.S. HEALTH CARE SYSTEM IS FROM REALIZING AND ACCEPTING THE TERM “INTEGRATED CARE”?

FF: I think that, conceptually, integrated care is broadly accepted in the health care field…the issue is how to make it a reality, which is going to involve reform at both the clinical level (how health care is delivered), and also at the provider payment level (how providers are paid). It is in its very early days, and the Affordable Care Act provides an historic opportunity to make integrated care a reality — an opportunity we should not miss.


CL: WHAT DO YOU THINK IS THE IMPACT TO THE PATIENT AND FAMILY CAREGIVER WHEN PROVIDERS FAIL TO COORDINATE CARE BETWEEN THE MEDICAL AND MENTAL HEALTH NEEDS OF THE PATIENT AND THEIR FAMILY?


FF: When there is a failure to coordinate care between medical and behavioral providers, there are poor health outcomes in both areas, which leads to persistence of illness and oftentimes failure to recover, as well as increased health care costs. I have personal experience for many years providing care for my sister who had schizophrenia, and I know firsthand the burden that care-giving puts on families and the most vulnerable patients in our society: the mentally ill. For the families, there is not only the stress of dealing with someone who is in an altered state of reality, but also the stress of having to facilitate the care coordination that the health care professionals should be establishing among themselves.


CL: WHAT DO YOU SEE WITH THE WORK THAT YOU’RE DOING AS POSSIBLE SOLUTIONS TO IMPROVING THE COORDINATION AND COMMUNICATION BETWEEN THE PHYSICAL HEALTH AND MENTAL HEALTH COMMUNITIES?


FF: *To begin implementing as widely as possible proven integrated care models. The Collaborative Care Model (www.teamcarehealth.org), developed by the AIMS Center in Washington, has been demonstrated to be the most effective model to date with the most robust results in terms of both health outcomes and cost savings. This model involves a team of health care providers in primary care that, for a period of time, wrap around the “complex” patient, providing coordinated, cross-disciplinary care, under the leadership of the primary care doctor, and include a care manager — usually a qualified nurse practitioner — and a consulting mental health professional. A weekly team review of the entire patient caseload, use of a common electronic health record and plan, a treat-to-target approach, and adjusting treatment where insufficient improvement is part of this model.


CL: IN UNDERSTANDING HOW IMPORTANT THE COLLABORATIVE CARE MODEL IS, DO YOU THINK THERE IS A ROLE FOR CASE MANAGEMENT IN ADDRESSING THE ISSUES FACING INTEGRATED CARE?

FF: The more I learn about case management, the more it becomes clear that the care manager plays a vital role in integrated care. In the medical setting, as noted earlier, the care manager is a critical member of the health care team. When we look at the specialty behavioral health setting, e.g., CMHCs, the first step to begin integrated care is introducing medical care management via care managers, usually full-time RNs. In both medical and mental care delivery settings, care managers are really at the hub of cross-disciplinary care, educating and assisting patients in a variety of ways, and coordinating between and among the providers and team members.


CL: THERE ARE CURRENTLY TWO BILLS IN CONGRESS: HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT 2013 AND STRENGTHEN MENTAL HEALTH IN OUR COMMUNITIES ACT. HOW MIGHT THESE HELP PATIENTS AND FAMILIES DEALING WITH MENTAL HEALTH ISSUES AND CONCERNS?

FF: It’s really wonderful that we have two landmark, comprehensive mental health bills pending in Congress focused on improving our mental health system. It presents another strategic opportunity to improve how mental and medical care are delivered. Both bills approach the subject differently, and our organization, like many others, would like to see the best provisions from both of these bills incorporated into one single bill to improve on the mental health system in this country.


CL: I COULDN’T AGREE WITH YOU MORE. ARE THERE ANY FINAL THOUGHTS YOU’D LIKE TO SHARE?

FF: I agree that over the last 10 to 15 years, we have come a long way in the U.S. in understanding the urgent need to improve our mental health care system, in terms of delivering quality care and ensuring broader access for consumers to seek care when needed. However, social stigma persists, and NHMH believes an important way to eliminate that stigma is not by talking about it, but by making integrated care a reality, so that Americans’ physical and behavioral conditions are addressed together in a coordinated fashion. We believe we have that opportunity now, but it’s going to take a lot of hard work on many levels and among diverse groups. Finally, I’d like to say that care managers and case management professionals are at the heart of this care delivery innovation. I can’t stress that enough.

Florence C. Fee, J.D. is Founder and President of NHMH and has been a mental health advocate for over 30 years as a longtime advocate and board member of NAMI (National Alliance on Mental Illness). Her work in mental health advocacy is continually inspired by the courageous struggle of two siblings with serious mental disorders, and the dedicated efforts of a “team” of family caregivers.


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