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(NHMH Note: What is happening in San Francisco with the lack of treatment for individuals with serious mental illness is a tragedy resulting from the City’s failure to find ways to provide effective treatment for the small, very vulnerable resident patient population with serious mental illness. A city endowed with wealth, health expertise, and the center of the global technology industry, should be able to do much better and serve as a model for other communities. A community’s wealth and expertise cannot solve basic mental health problems alone without input from those on the front-lines especially patients, families and providers like Dr. Okin. There must also be a willingness by communities and their leaders to actually make meaningful changes that require cooperation across “silos,” and the end of fragmented care, where physical and mental health care are delivered in separate, independent care delivery systems. And replaced with the delivery of integrated medical and behavioral care.)

San Francisco’s War Against the Mentally Ill – An Op-Ed by San Francisco psychiatrist Robert L. Okin, M.D.

“Last month’s violent attack on San Francisco resident Paneez Kosarian allegedly by a homeless, mentally ill man in front of her condo building …..”

(Read More) SFChronOpEdOkin


NHMH Board Member Interviewed on NPR Discussing Need for Integrated Physical-Mental Healthcare

Dr. Roger Kathol explained on NPR why untreated mental health issues can and often do impede or prevent physical conditions improving or resolving. The fact is both our physical and behavioral conditions are inextricably inter-connected and thus need to be addressed in a coordinated fashion. Why NHMH works every day to have effective integrated care available in all medical settings including primary care.



Depression and Pregnancy

Three other national behavioral health organizations joined NHMH in our June 4, 2019 letter to the U.S. Senate Committee on Health (HELP).  The Committee’s bill on health care cost savings currently omits any mention of integration of medical-behavioral care services in its draft provisions.  NHMH pointed out that while the bill raises the topic of pregnant postpartum women healthcare …  it fails to offer support for integrated care delivery for depression care in the OB-GYN setting.  Yet …  depression is one of the most common problems pregnant women face.  OB-GYN doctors have less training in depression care than do other PCPs.  They need training and resources to allow them to provide follow-up mental health for their OB-GYN patients.  See our letter for more information … and urge your U.S. Senator to recognize that healthcare services delivery is JUST AS important as treatments …. what good are treatments that we have, such as depression treatments, if we cannot effectively deliver them to patients??!!



NHMH Cited in Politico Piece on Senate Murphy-Cassidy Mental Health Parity Bill

CHRIS MURPHY, BILL CASSIDY introduce measure to strengthen mental health parity. The Connecticut Democrat and the Louisiana Republican, who have teamed up on a series of mental health reforms, say that their bill will reduce administrative barriers that are limiting patient access.
“Our legislation will require insurance providers to give the same access to care for someone with a mental health diagnosis as they do for someone with a broken leg, and it will crack down on bad actors to make sure they do,” Murphy said.
The American Psychiatric Association, the American Psychological Association and 54 other groups support the bill. Rep. Katie Porter (D-Calif.) plans to introduce companion legislation in the House.



New Harris Poll Shows Majority of Americans Now Think Mental Disorders are Nothing To be Ashamed of and Can Be Treated Effectively

In a Harris poll commissioned by the American Psychological Association, it is clear the American public has moved significantly towards greater understand of mental disorders and acceptance of fact that effective treatments exist for behavioral conditions and should be accessed when needed. These changes in U.S. popular opinion reveal two things:

  1. The work of advocacy groups like NHMH and others are having a real effect, and
  2. As more Americans seek mental health care, NHMH’s mission becomes all the more critical: to ensure that effective, evidence-based care will in fact be available to them in primary care, when they seek that care.


An Important New Trend for American Patients: Large U.S. Employers Negotiating Health Benefits Directly with Doctors/Hospitals

Employers are one of the key players in how Americans receive health care: employers spending on healthcare services increased by 44% per enrollee from 2007-2016, reaching an annual amount of nearly $700 billion in 2017, roughly what the Pentagon spends on defense. And it is not resulting in employee/patients receiving quality and cost effective care. Which quality care can and should include patients receive behavioral health services in their primary care clinics. Employers are now changing the rules of the game, and starting to negotiate directly with providers. Harvard Business Review details what’s happening in this potentially game-changing development.

Most U.S. Teens See Anxiety and Depression as a Major Problem Among Their Peers

SURVEY — TEENS CITE ANXIETY, DEPRESSION AS MOST PREVALENT PROBLEMS: Most teens see anxiety and depression as “major problems” among their peers, according to a new survey conducted by the Pew Research Center. It suggests that 7 in 10 teens ages 13 to 17 think those issues are more prevalent than bullying, drug addiction, drinking alcohol, poverty, teen pregnancy and gangs. (Politico, February 21, 2019).

NHMH talks to Amazon in Arlington Virginia

On February 1, 2019 NHMH’s Executive Director met with Amazon’s Director of Global Community Engagement, Alice Shobe, in Arlington, Virginia, to brief Amazon executives on NHMH mission federal advocacy programs. Amazon recently announced that its second U.S. corporate headquarters, outside of Seattle, will be in Arlington, VA, where NHMH maintains a branch office. Also located in Arlington is the Virginia Hospital Center, an affiliate of the Mayo Clinic, and which provides medical-behavioral integrated services to Arlington patients. In 2018 Amazon, along with JP Morgan and Berkshire Hathaway, created a new entity to address healthcare delivery innovations for its combined one million employees, naming Atul Gawande, MD as its CEO.

See our Social Media for more information:



PCORI SPIRIT Clinical Trial Reaches Halfway Points (NHMH on Stakeholder Committee)

NHMH has reached the mid-way point is its landmark 5-year PCORI SPIRIT RCT clinical trial, running from Jan 2016 to Dec 2020. The trial integrates psychiatric treatment for two complex mental disorders (bipolar disorder, PTSD) in rural, under-served community health clinics across three states (WA, MI, AR), via two tele-psychiatry interventions, collaborative care and enhanced referral. NHMH is a member of the SPIRIT Stakeholder Committee. The trial formally ends December 31, 2020. SPIRIT researchers will submit their findings report to PCORI (Patient-Centered Outcomes Research Institute) in June 2021.

SPIRIT Website

Mental Health Care Part of Disaster Planning

CDC INTEGRATING MENTAL HEALTH IN HURRICANE PREPAREDNESS — In the wake of Hurricane Florence and before Hurricane Michael makes landfall in Florida’s panhandle, the CDC is working to further integrate mental health into its natural disaster preparedness strategy. A new post by CDC researchers says the agency wants to fill the gap in real-time information on mental health needs amid disasters, particularly by focusing on the needs of children during and after natural disasters. Researchers say children are more psychically vulnerable in emergencies than adults for a variety of reasons. Read the post here:

(October 2018)

Who Do Healthcare Leaders Consider Examples of High Performing Organizations?? The Aviation industry and Amazon!!

According to a health leadership survey just published by the respected New England Journal of Medicine, you may be surprised by what health execs and clinical leaders say they think are exemplars of well-run quality organizations! Integrated team-based care appears high as an indicator of quality among healthcare concerns.

Click here to read more

NHMH Advocacy in Washington, D.C. on Behalf of Integrated Medical-Behavioral Care Results in Substantial Progress

On September 28, 2017 the full Senate passed on the Senate floor and advanced the CHRONIC Act of 2017, a bill that NHMH has long inputted into in the Senate Finance Committee.

In 2016, behavioral integration into primary care was one of four Chronic Care policies that the Center for Medicare & Medicaid (CMS) implemented through the Physician Fee Schedule (MACRA) rule. Because CMS took that action before the discussion draft of this bill was released, those policies did not need to be included in the legislation; it had already become federal policy through the CMS rule. The Senate Finance Committee (SFC) had sent a October 27, 2016 letter to CMS commending it for incorporating the four policies (including BHI) in the CY 2017 PFS final rule. The SFC’s Chronic Care Working Group, led by Sens. Issakson and Warner, has been a strong bipartisan driver for care improvements for Medicare beneficiaries with (costly) chronic conditions.

The bipartisan Chronic Care Act of 2017 now goes to the House of Representatives for a vote, and then on to the White House for signing into law.

The CMS Rule related to the Act changed federal health policy to promote the integration of behavioral health care. This is an effort NHMH has worked on steadily over the past 5 years. It will allow Medicare to pay physicians in primary care who provide two key elements of the collaborative care model of integrated care: the services of a consulting psychiatrist and care manager. The goal in the U.S. Senate and in CMS has been to improve the integration of care for Medicare beneficiaries living with a chronic physical condition (e.g. arthritis, diabetes, heart disease etc etc) combined with a behavioral health condition (e.g. depression, anxiety etc etc). While it remains challenging for most primary care practices to be able to provide the evidence-based collaborative care model of integrated care, this new CMS payment policy is an important milestone on the path to help practices offer effective mental health services in primary care.

Both the 2017 Chronic Care Act and the 2016 CMS Rule recognize the pressing need to address the prevalence of Medicare patients’ co-occurrence of both physical and mental health issues, and to provide primary care doctors with the ability to offer integrated care services. NHMH is proud to have played a strong advocacy role in this progress getting effective mental health care into the general medical setting where many more patients with behavioral conditions can access care.

Mind Your P’s & Q’s … and Your PHQs (Patient Health Questionnaire)

On August 23, 2017, Google, the world’s most popular search engine, announced it would begin providing a validated mental health screening tool (ie widely accepted by science and medicine), called the PHQ-9, to internet users who search online for information on depression.

The PHQ-9 (“Patient Health Questionnaire-9” has 9 questions for patient to answer.* It is widely used by doctors in primary care practices to screen for depression. And is in fact recommended by national health experts (U.S. Preventative Services Task Force, 2016) as one of several screening tools that can be considered for ALL adults over 18.

Research shows the PHQ-9 does a good job of identifying people who are at risk of having depression, a highly treatable mental health condition. It allows doctors to measure levels of depression symptoms. Patients who complete the PHQ-9 receive a score indicating the severity of their symptoms which can then help a doctor’s diagnosis and treatment plan if needed.

There are effective treatments for depression. NHMH – No Health w/o Mental Health highly recommends that those who complete the PHQ-9 online, then take their questionnaire results to their primary care doctor and discuss it with him/her to find out what it means and how you can be helped. Get a diagnosis and treatment in the clinical setting. There are effective treatments for depression and other common mental disorders and the PHQ-9 will help speed you toward care and full functioning!

PHQ-9 Questions:

  1. Little interest or pleasure in doing things?
  2. Feeling down, depressed or hopeless?
  3. Trouble falling or staying asleep, or sleeping too much?
  4. Feeling tired or having little energy?
  5. Poor appetite or overeating?
  6. Feeling bad about yourself — or that you are a failure or have
    let yourself or your family down?
  7. Trouble concentrating on things, such as reading the newspaper or watching tv?
  8. Moving or speaking so slowly that others could have noticed? Or the opposite –
    being so fidgety or restless that you have been moving around a lot more than usual?
  9. Thoughts that you would be better off dead or of hurting yourself in some way?


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NHMH Salutes the Passing of American Scientist Dr. Paul Greengard, a Pioneer in Brain Research and Mental Health Treament. We owe Dr. Greengard a great debt for his incredible, break-through work, and his amazing life of service.

San Francisco's Fragmented Mental Health Services Are Literally Killing Its CitizensSan Francisco’s fragmented city services are harming – and killing – the most vulnerable,S.F. Chronicle, Michael Cabanatuan Sep. 27, 2022 “A small number of San Franciscans — almost all of them unhoused — are responsible for overly heavy use of both the city’s medical and legal systems — but the systems’ fragmented approach is failing, according to a new study. The study, from the nonpartisan California Policy Lab and the Benioff Homelessness and Housing Initiative at UCSF, shows that a small group of people are repeatedly cycling in and out of both the county’s health and criminal legal systems each year and represent a disproportionately high amount of utilization of these systems.The systems provide fragmented care that fails those who use it, the study’s authors said, and one finding backs that up: Nearly one in four of the people with heavy use of both systems in 2011 were dead by 2020, “reflecting how vulnerable these individuals are and how high the stakes are for improving the systems that support them,” said co-author Dr. Hemal Kanzaria, medical director at Zuckerberg San Francisco General Hospital and an associate professor of emergency medicine at UCSF.The study underscores what health care workers and public hospital officials told city leaders in July — that far too many people struggling with severe mental illness and addiction cycle through San Francisco’s overburdened emergency rooms, failing to get long-term help, and at a high cost to the city. For instance, just five people in the past five years accounted for 1,781 ambulance transports, possibly up to 2,000, at a cost of $4 million.The study’s authors called for a more coordinated approach, such as connecting people released from the emergency room or jail with housing and continued care. “Our research highlights the need for coordinated, evidence-based interventions to address these individuals’ complex needs, promote stable housing, and prevent poor health outcomes including untimely death,” said co-author Dr. Maria Raven, chief of emergency medicine at UCSF Medical Center and co-lead of the Benioff Homelessness and Housing Initiative program on adults with complex needs.The study looked at 10 years of data from 270,000 people who used the city’s acute medical care or legal systems between 2011 and 2020. It narrowed its focus to two groups of people who had interactions with both systems in the same year, one from 2011 and one from 2020, to investigate trends among frequent users of city services.The study is unusual, researchers say, because it links data from multiple agencies to see how people are using critical city services including mental and physical health care and housing over a several-year period.Among the study’s findings, according to the Policy Lab:• About 24% of the 2011 group continued their high use of both systems the following years but their use declined each of the following years. • Between 80% and 90% of the people in the 2011 and 2020 groups had substance use problems and many also had chronic mental and and physical health issues. • More than 90% of the individuals in both groups had been booked into jail for a felony and a misdemeanor. • The research team determined that many of the people in the 2020 group were in San Francisco in 2011 and had contact with both health and criminal legal systems in the prior 10 years. For example, 30% of the 2020 cohort was booked into jail in 2011.” Michael Cabanatuan is a San Francisco Chronicle staff writer, email: ... See MoreSee Less
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