Lessons in Youth Suicide Prevention.ppt

							Integrating Mental Health Into
Primary Care

         Bringing Mental Wellness to
         the Medical Home
The Tipping Point

   The research base and implementation
   experience to date has provided a solid
   framework for continued efforts to
   promote integration.

   All it needs is some
   pushing….


                  Mental Health Association
Serendipity


  This all began because I was sitting
  next to the editor of the Wisconsin
  Medical Journal at a meeting…




               Mental Health Association
From Project to Priority

    State made this a priority for our grant.
    Held a “summit” in Sept. 2005.
    Strategic planning process followed.




                      Mental Health Association
4 Components to Integration Efforts

    PCP Education and Resources

    Health Systems Advocacy

    Pilot Projects

    Policy Change



                      Mental Health Association
PCPs: Overcoming Barriers

    PCPs are increasingly knowledgeable about
     mental health issues but face barriers to
     screening and intervention




                    Mental Health Association
PCPs: What They Want

  Access to psychiatric consultation.
  Information about appropriate tools for use in
   primary care.
  Time and reimbursement for their time.




                    Mental Health Association
PCPs: What We’ve Done

    Wisconsin Medical Journal

    Presentations at professional events

    Information on website

    Pediatric Screening Project



                     Mental Health Association
PCPs: What’s Up Next


  Psychiatric Consultation Capacity




                Mental Health Association
Health Systems Advocacy

  Health plans and systems have actually been
   the most active in our Sharing Patients
   conferences.
  HMOs especially have the ability to address
   the institutional barriers to integration.




                   Mental Health Association
Health System Activities

    Had champion from one HMO who has
     been willing to present what they’re
     doing.
    Obtained information from other health
     plans about what they’re doing.

    FQHCs have had national effort: PH
     administrator has been a champion.

                   Mental Health Association
Sharing Patients

  Making the case for integration.
  Presentations from people who are doing this.
  Educational presentations on special issues:
        Children
        Post Partum Depression
        Older Adults

    Sept. 05 and Oct. 06



                        Mental Health Association
Health Systems: What’s Next


    Potential to work with HMOs: improving their
     HEDIS scores.




                     Mental Health Association
Implementation: PHQ-9


    Set up a small workgroup which included:
        Full service HMO
        Speciality managed care provider
        FQHC
        Employer-based health provider
    How can we use PHQ-9 to screen and track
     outcomes?



                        Mental Health Association
PHQ-9

    Process has been difficult; people doing this in
     midst of larger organizational changes.
    Continues to be interest in understanding how
     to do best do this.




                      Mental Health Association
Implementation: Teen Screen

    As part of a separate effort one of our
     health plans has implemented use of
     TeenScreen in the primary care setting.
        All well child visits; 10-18

        Schedule time 15 minutes prior to visit

        Training for pediatricians.

                         Mental Health Association
Implementation: SBIRT

  SAMHSA does not allow depression
   screening as part of SBIRT grants
  But WI has included this:
      Participating clinics have paid for part of HE
       costs
      Another grant is subsidizing development of
       model protocols.



                     Mental Health Association
Implementation: Systems Change

    Worked with a large health system in
     Milwaukee interested in doing a major
     effort towards integration.




                   Mental Health Association
Systems Change

  Facilitated “summit”
  Buy-in from administrators
  Keynote presented argument for
   integration
  Break-outs gave administrative and
   medical staffs the opportunity to have
   input.


                 Mental Health Association
Systems Change

    Key Recommendations
        Increase co-location of BH providers

        “Directory” and “triage” line for PCPs

        Brown bags

        “Curbside consultation”

                       Mental Health Association
Policy Change

    Group wanted to tackle “low-hanging
     fruit”




      Clarify Medicaid billing for MH in primary
       care
      Enhance telemedicine policies


                     Mental Health Association
Policy and Practice Changes


    But other changes are more challenging:

        Reimbursement for care managers

        Reimbursement for consultations

        Co-location of MH providers

                       Mental Health Association
Lessons Learned

 1. There is a lot of interest in this topic!
     We started from scratch and now have
      over 200 people involved
     A number of champions have stepped
      up in substantive ways
     “Opportunities” are everywhere




                 Mental Health Association
Lessons Learned

2.    The groundwork has been laid in terms of
      both research and practice.

     You are not
     reinventing
       the wheel



                    Mental Health Association
Lessons Learned

 3.   The biggest barrier is engaging PCPs
      and their professional organizations.




                   Mental Health Association
Lessons Learned


 4.   Talk to the person sitting next to you.




                    Mental Health Association
On-line Resources: Wisconsin

   Mental Health America
   of Wisconsin
   www.mhawisconsin.org/
    Sharing Patients
    Links to Articles/WMJ

    Fact Sheets




                  Mental Health Association
On-line Resources: Others

   Macarthur Initiative:
 http://www.depression-primarycare.org/

 Robert Wood Johnson Foundation




                 Mental Health Association
Contact Information


              Shel Gross

            608-250-4368

          shelgross@tds.net



              Mental Health Association