How Psychiatric Access Programs are Bridging the Behavioral Health Divide and Filling the Psychiatric Shortage

Transcription

1 How Psychiatric Access Programs are Bridging the Behavioral Health Divide and Filling the Psychiatric Shortage Presented by Christine Andersen, MS, LPC Director of Integrated Care

2 The Landscape Has Changed 2

3 Regional Accountable Entity (RAE) Regions 3

4 Northeast Health Partners Beacon RAE Affiliations Health Colorado Inc. 4 4

5 Questions 1. What are the barriers you have experienced accessing mental health services personally and/or professionally? 2. What are your concerns about addressing suicide risk? Please write your responses on the provided note cards. When you are done pass the cards up to the front please. 5

6 The Problem: A Severe Deficiency in Psychiatry 6

7 Mental Health in Primary Care Patients with behavioral health problems as many as 80 percent present in emergency departments and primary care clinics, where providers often lack the time, training, and staff resources to recognize and treat behavioral health conditions. Nearly 60% of patients treated for depression in the United States receive treatment in the primary care setting 79% of primary providers prescribe antidepressant medications 6

8 Impact of Mental Health and Physical Health 8 7

9 10 Most Common Complaints in Primary Care : Chest pain Back pain Fatigue Shortness of breath Dizziness Insomnia Headache Abdominal pain Swelling Numbness Chronic conditions that require behavioral health component in standard of care protocols: Asthma Diabetes CVD Irritable Bowel Syndrome Obesity Substance Abuse 8

10 Participation in Behavioral Health Services Some patients do enter the behavioral health system, where the vast majority of behavioral health providers work at independent practices, clinics and hospitals that treat mental health problems exclusively Many patients referred for behavioral health treatment do not follow through, adding to the cohort of patients who receive no mental health care Stigma and ease of accessing a behavioral health provider, are the most common barriers for patients. 10

11 Integrated Care 11

12 Types of Collaboration Between Medical and Behavioral Health Services Coordinated = Behavioral services by referral at separate location with formalized information exchange. Co-Located = By referral at medical care location Integrated = Part of the medical treatment at the same medical care location 12

13 How Psychiatric Access Programs Fit Psychiatric Access program services help fill gaps that may occur even in an integrated care setting. Improve practitioners comfort in assessing and treating behavioral health conditions Psychiatric access programs can support practices who are not yet integrated. 13

14 History of Psychiatric Access Programs The first child psychiatry access project pilot in the United States was initiated in 2003 when CMS and MassHealth provided a grant to Dr. Ronald Steingard and UMass Medical school and he developed the pilot program. TCPS- Targeted Child Psychiatric Services provided consultation to pediatricians around behavioral health issues and prescribing of psychotropic medications. In 2004 TCPS was adapted by Pediatrician John Straus, MD who designed the model to address that shortage of child mental health providers across Massachusetts. With legislative approval the Department of Mental Health funded the statewide roll out of 6 regional teams in and The Massachusetts Child Psychiatry Access Project (MCPAP). The results over 3 years from the project were published and because of the success variations of the model have been replicated in over 20 States. Visit NNCAP for more information on other programs. 14

15 C-PAC Program Components Psychiatric Curbside Consultation available to an enrolled practice, regardless of insurance carrier and for all patient ages. Available within 30 minutes of request during normal business hours. Behavioral Health Referral - available when patients need more care than the PCP can offer within their clinic. C-PAC staff are available for behavioral health coordination and work in conjunction with care coordination teams. Education and Training involves structured training for PCPs on specific behavioral health topics including psychopharmacology. This is performed in formats that work for the specific practices. 15

16 Evaluation Results The first two years C-PACK (for kids) was administered under a grant and the outcomes were positive: 89% of PCP s screen more patients 87% of PCP s used more screening tools 88% of PCP s were more comfortable addressing behavioral health issues in primary care settings 64% collaborated more with behavioral health specialists 16

17 Educating Primary Care About Suicide Prevention The Facts: On average of 45% of those who die by suicide saw their primary care physician in the month before their death, and 77% had contact with in a year. Compared to only 20% who saw a mental health provider in the preceding month Generalists write the most antidepressant prescriptions (62%) in the U.S. 17

18 Where to start The most important thing you can do is ASK Are you thinking about killing yourself? Understand the progression of risk: 1. Having thoughts of death 2. Having thoughts of suicide 3. Making a plan/has considered a method for suicide 4. Having access/available means to carry out plan 5. Intent to carry out the plan and access to means 18

19 Lethal Means and Prevention 19

20 Know Your Resources 20

21 Path to Zero Suicide 21

22 Questions? Thank you 22

23 How to Enroll in Beacon s Psychiatric Access Program To Enroll in C-PAC: Visit our website: Or Contact Elizabeth Richards, MSW, LCSW, C-PAC Supervisor at Your primary care practice must be located in RAE Region 2 or 4 23