THE BASICS

The Basics

  • “A Broken System When It’s Needed Most” – as NHMH has advocated since its creation 13 years ago, it is an urgent need in our country to make effective mental health care available where the majority of behavioral health patients go, i.e. medical settings such as primary care. COVID-19’s after-math is highly likely to make this reality widely understood. The solution: The federal and state governments (through Medicare and Medicaid), and private insurance companies, must pay for and reward clinicians who integrate evidence-based behavioral health services into their primary care practices. Rather than costing our healthcare system more, it will mean substantial cost savings, given fact it will lower medical expenditure costs. This is the future — behavioral health services integrated into medical settings — that NHMH has long recognized and worked for and the C-19 pandemic has shown is critically needed.

    https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/

  • There are proven successful behavioral health treatments possible in primary care –such as collaborative care (psychiatrist consults to medical doctor and is part of care team along with a care manager), embedded behavioral professionals (psychologist, social worker with office down hall from medical doctor), behavioral screening, short brief behavioral interventions …however, the vast majority of medical practices are not providing them to patients due to time, financial and other practice constraints;

  • Two-thirds of primary care doctors say they have significant problems getting patients with mental disorders into mental health care; this is a big frustration for primary care doctors;

  • A disconnect exists in our health system where behavioral services are carved out, handled separately from rest of the medical system forcing patients to navigate two systems for care;

  • The commercial health insurance industry needs to incentivize integrated models such as collaborative care, not discourage these integrated systems as behavioral carve-outs do;

  • Now behavioral care functions completely independently of medical healthcare, with different care delivery systems and different provider networks, with little or no communication between the two;

  • 70% of patients with behavioral issues go only to the medical setting; and only half of primary care patients referred by their medical doctors to the behavioral health sector, go, and among those who do the average number of visits is two;

  • Medical doctors have not been trained to treat behavioral health issues;

  • 95% of behavioral professionals (psychiatrists, psychologists) work only in the behavioral setting where only 25% of behavioral patients are!

  • Among most costly patients in our health vstr system are those with co-existing chronic medical issues and behavioral issues, they represent 15% of patients yet account for 60% of total U.S. healthcare costs; treating them successfully and early is a big cost savings opportunity.

  • Behavioral health should be like every other medical sub-specialty (e.g. oncology, pediatrics, obstetrics, etc) with behavioral providers part of medical networks, care delivered together and health plan benefits encompassing both treatment for physical and behavioral in one plan.

  • A specialty behavioral health sector will still be needed for patients with serious mental illness like schizophrenia, major bipolar disorder, or major depressive disorder, but they are only 10% of all behavioral patients.

RESOURCES

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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.

https://www.rockefeller.edu/news/25634-pioneering-neuroscientist-nobel-laureate-paul-greengard-dies-93/

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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: mcabanatuan@sfchronicle.com ... See MoreSee Less
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