Partnering for the Future of Behavioral Health

Transcription

1 APNA 25th Annual Conference Friday, October 21 - Keynote: Session 3001 Partnering for the Future of Behavioral Health Pamela P l S. S Hyde, H d J.D. JD SAMHSA Administrator American Psychiatric Nurses Association (APNA) 25th Annual Conference Anaheim, CA October 21, 2011 Administrator Pamela S. Hyde, JD 1

2 FOCUS AREAS FOR TODAY S DISCUSSION 3 SAMHSA S FOCUS & STRATEGIC INITIATIVES SI FOCUS PREVENTION SI FOCUS TRAUMA & JUSTICE SI FOCUS RECOVERY SUPPORTS SI FOCUS HEALTH REFORM SI FOCUS DATA, OUTCOMES & QUALITY SI FOCUS PUBLIC AWARENESS & SUPPORT / NATIONAL DIALOGUE FOCUS ON PEOPLE & COMMUNITIES: PREVENTION & RECOVERY People NOT money, diseases, programs, or authorities People come to us with multiple diseases/conditions, multiple social determinants, multiple cultural backgrounds and beliefs Mission reduce the impact of substance abuse p and mental illness on America s communities Behavioral health is essential to health Collaborating more between SA and MH; and between BH and primary care 4 Administrator Pamela S. Hyde, JD 2

3 FOCUS: SAMHSA S STRATEGIC INITIATIVES 5 1. Prevention 2. Trauma and Justice 3. Military Families 4. Recovery Support 5. Health Reform 6. Health Information Technology 7. Data, Outcomes & Quality 8. Public Awareness & Support STRATEGIC INITIATIVE 1.Prevention 6 Prevent Substance Abuse and Mental Illness (Including Tobacco) and Build Emotional Health Suicide 1.Prevention Underage Drinking/Alcohol Polices Prescription Drug Abuse Administrator Pamela S. Hyde, JD 3

4 10 Leading Causes of Death, United States 2008, All Races, Both Sexes 7 RANK ALL AGES 1. Heart Disease: 616, Malignant Neoplasms: 565, Chronic Low Respiratory Disease: 141, Cerebro vascular : 134, Unintentional Injury: 121, Alzheimer's Disease: 82, Diabetes Mellitus: 70, Influenza & Pneumonia: 56, Nephritis: 48, Suicide: 36,035 WISQARS TM Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System SUICIDE: FACTS 8 Administrator Pamela S. Hyde, JD 4

5 TOUGH REALITIES 9 AGE AGE 18 AND HAD SERIOUS THOUGHTS OF SUICIDE 2.9 million, 13.8% 8.4 million, 3.7% MADE A PLAN 2.3 million, 10.9% 2.2 million, 1% ATTEMPTED SUICIDED 1.3 million, 6.3% 1.1 million,.05% DIED BY SUICIDE >1,000 >35,000 TOUGH REALITIES percent of those who die by suicide were afflicted with major depression the suicide rate of people with major depression is 8 x s that of the general population 90 percent of individuals who die by suicide had a mental disorder Administrator Pamela S. Hyde, JD 5

6 TOUGH REALITIES ~30 percent of deaths by suicide involved alcohol intoxication BAC at or above legal limit Four other substances were identified in ~10 percent of tested victims amphetamines, cocaine, opiates (both prescription and heroin) and marijuana TOUGH REALITIES : 2009: 55% in emergency department visits for drug related suicide attempts by men 21 to : 49% in emergency department visits for drug related suicide attempts by women 50+ Every year > 650,000 persons receive treatment in emergency rooms following suicide attempts Administrator Pamela S. Hyde, JD 6

7 MISSED OPPORTUNITIES = LIVES LOST 77 percent of individuals who die by suicide had visited their primary care doctor within the year 13 THE QUESTION OF SUICIDE WAS SELDOM RAISED 45 percent had visited their primary care doctor within the month 18 percent of elderly patients visited their primary care doctor on same day as their suicide TOUGH REALITIES : More than 1, members of the Armed Forces took their own lives; an average of 1 suicide every 36 hours Suicide among veterans accounts for as many as 1 in 5 suicides in the U.S. U.S. Army suffered a record 32 suicides in July, the most since it began releasing monthly figures in 2009 Administrator Pamela S. Hyde, JD 7

8 MISSED OPPORTUNITIES = LIVES LOST Individuals discharged from an inpatient unit continue to be at risk ikfor suicide iid ~10% of individuals who died by suicide had been discharged from an ED within previous 60 days 15 ~ 8.6 percent hospitalized for suicidality are predicted to eventually die by suicide NATIONAL ACTION ALLIANCE FOR SUICIDE PREVENTION A public private partnership established in 2010 to revise and advance the National Strategy for Suicide Prevention (NSSP) Leadership: John McHugh, Secretary of the Army Former Senator Gordon H. Smith, Pres/CEO, Nat l Assoc of Broadcasters Vision: The National Action Alliance for Suicide Prevention envisions a nation free from the tragic experience of suicide Priorities: 1: Update/implement the Surgeon General s NSSP by : Public awareness and education 3: Focus on suicide prevention among high risk populations Administrator Pamela S. Hyde, JD 8

9 NATIONAL ACTION ALLIANCE FOR SUICIDE PREVENTION 17 Improve training of healthcare professionals to recognize, assess, and manage patients and clients at increased risk for suicide NEW REPORT: SUICIDE CARE IN SYSTEMS FRAMEWORK NATIONAL ACTION ALLIANCE: CLINICAL CARE & INTERVENTION TASK FORCE 18 Administrator Pamela S. Hyde, JD 9

10 STRATEGIC INITIATIVE 2. Trauma and Justice Trauma informed care and screening; trauma specific services Collaborate to address childhood trauma within juvenile justice and child welfare Adult trauma screening and brief interventions Court collaboratives to address persons with MI and/or addictions impact of disasters on BH of individuals, families, and communities 19 IMPACT OF TRAUMA 1 Trauma strongly associated with M/SUDs 20 More than 6 in 10 U.S. youth have been exposed to violence within the past year; nearly 1 in 10 injured 772,000 children were victims of maltreatment in 2008 Adverse childhood experiences (ACEs, e.g., physical, emotional, and sexual abuse, as well as family dysfunction) associated with mental illness, suicidality, substance abuse, and physical illnesses Administrator Pamela S. Hyde, JD 10

11 IMPACT OF TRAUMA study: 18.5 percent of returning veterans reported symptoms consistent it twith post traumatic t ti stress disorder d (PTSD) or depression > Half of all prison and jail inmates have mental health problems; 6 in 10 have a substance use problem; > onethird have both Serious physical injury and psychological trauma from seclusion & restraint; 1998, Harvard Center for Risk Analysis estimated deaths due to S&R at 150 per year 21 RATES OF INJURIES AND ILLNESSES FOR SELECTED HEALTHCARE AND PROTECTIVE SERVICE OCCUPATIONS, BY OWNERSHIP, Administrator Pamela S. Hyde, JD 11

12 SECLUSION AND RESTRAINT/ PSYCHIATRIC INPATIENT VIOLENCE 23 Staff may inadvertently tl precipitate it t violence, which results in restraint or seclusion Violence in only 11 percent of S&R episodes One study: 90 percent of staff injuries resulted from staff patient physical contact interventions and 50 percent were specifically related to use of the patient restraint process SECLUSION & RESTRAINT AS NEVER EVENTS 2003: APA crested a task force on patient safety & adopted S&R use as a priority Psychiatry now recognizes S&R as medical errors New parameters for compensating care resulting in a medical error or hospital acquired condition Certain never er events ents no longer be compensated CMS Preventable adverse events w/serious consequences for the patient that should never happen in healthcare 24 Administrator Pamela S. Hyde, JD 12

13 NEW REPORT: The Business Case for Preventing and Reducing Restraint and Seclusion Use 25 Digital Version at ASK: WHAT HAPPENED TO YOU? INSTEAD OF WHAT S WRONG WITH YOU? Current BH workforce needs understanding of and training on: Role of trauma in people s lives Centrality of trauma to BH disorders Trauma specific interventions Strategies to build trauma informed systems Practitioners/systems need better understanding of how policies, practices, and behaviors can promote healing/recovery or be secondarily traumatizing 26 Administrator Pamela S. Hyde, JD 13

14 STRATEGIC INITIATIVE 4. Recovery Support 27 HOME Permanent Housing HEALTH Recovery Individuals and Families COMMUNITY Peer/Family/ Recovery Network Supports PURPOSE Employment/ Education FOCUS: RECOVERY WORKING DEFINITION 28 Administrator Pamela S. Hyde, JD 14

15 RECOVERY PRINCIPLES 29 Person centered Supported by addressing trauma Involves individual, family and community strengths and responsibility Occurs via many pathways Holistic Culturally based and influence Based on respect Supported by peers Supported through relationships Emerges from hope RECOVERY ACTIVITIES EXAMPLES Recovery Support Strategic Initiative 30 Recovery Support Services in Health Reform & Block Grant Recovery definition, principles, outcome measures Recovery curricula for/with practitioners Recovery TA Center (BRSS TACS) Administrator Pamela S. Hyde, JD 15

16 APPLAUSE TO APNA s FOCUS ON RECOVERY 31 Created Recovery Council Created Consumer Advisory Council to inform Recovery Council and all of APNA Great work in Recovery into Practice Grant STRATEGIC INITIATIVE 5. Health Reform 32 Essential Benefits Enrollment Uniform Block Grant Application TA to States Service Definitions w/ Medicaid (health homes, rules/regs, good & modern services, screening, prevention) and Medicare (dually eligible pops, Annual Wellness Visit) Primary/Behavioral Health Integration Administrator Pamela S. Hyde, JD 16

17 BEGINNING IN 2014: 32 MILLION MORE AMERICANS WILL BE COVERED mil HEALTH REFORM IMPACT OF AFFORDABLE CARE ACT More people will have insurance coverage Medicaid (and States) will play a bigger role in M/SUDs Focus on primary care & coordination w/ specialty care Emphasis on home & community based services; less reliance on institutional & residential care (health homes) Priority on prevention of diseases & promoting wellness Focus on quality rather than quantity of care (HIT, accountable care organizations) Behavioral health is included parity 34 Administrator Pamela S. Hyde, JD 17

18 STRATEGIC INITIATIVE 7. Data, Outcomes & Quality 35 National Behavioral Health Quality Framework Part of National Quality Strategy to Improve Health Care Working with NQF and Others on Measures Use of SAMHSA Tools to Improve Practices Models(e.g., SPF, coalitions, SBIRT, SOCs, suicide prevention) Emerging science (e.g., oral fluids testing) Technical assistance capacity (e.g., trauma) Partnerships (e.g., HIT meaningful use; Medicaid/Medicare) Services research as appropriate GOALS 36 Prevention, Treatment and Recovery Supports that are: Effective Person & Family Centered Coordinated Eid Evidence based dor Best Practices Safe Affordable & High Value for Cost Administrator Pamela S. Hyde, JD 18

19 MEASURES 37 SAMHSA Funded Programs Practitioner/Program/Systembased Populationbased A NATIONAL DIALOGUE Behavioral Health seen as social problem rather than public health issue 8. Public Awareness & Support 38 Communities/Governments Respond to Social Problems Rather Than to Health Needs of People and Community BH Field Has Multiple Philosophies Resulting in Multiple and Inconsistent Messages Disease; disability; chronic medical condition; social reaction to difference; brain/genetic; environment/psychosocial Administrator Pamela S. Hyde, JD 19

20 TRAGEDIES 39 Grand Rapids, MI Tucson, AZ Lost Lost Fort Hood, TX Lost Virginia Tech, VA Lost West Nickel Mines School, PA Lost Red Lake Band of Chippewa, MN Lost Columbine High School, TX Lost PUBLIC EVENTS LEAD TO INACCURATE PUBLIC DIALOGUE Individual Blame Based on Misunderstanding E.g., g, moral judgment, discrimination, prejudice, social exclusion OR Attention to symptoms E.g., homelessness; drug related gangs; child welfare issues due to addiction and mental illness; amount of jail time by persons with M/SUDs; institutional, provider, or system failures LEADING TO Insufficient responses E.g., increased security & police protection; tighter background checks; controlled access to weapons; legal control of perpetrators & their treatment; more jail cells, homeless shelters, institutional/system/provider oversight) 40 Administrator Pamela S. Hyde, JD 20

21 DAILY DISASTER OF UNPREVENTED AND UNTREATED M/SUDs 41 Any MI: 45.1 million SUD: 22.5 million Diabetes: 25.8 million Heart Disease: 81.1 million Hypertension: 74.5 million 37.9 % receiving treatment 11.6 % receiving treatment 84 % receiving treatment 74.6 % receiving screenings 70.4% receiving treatment WHAT AMERICANS KNOW 42 Most Know or Are Taught: Basic First Aid and CPR for physical health crisis Universal sign for choking; facial expressions of physical pain; and basic terminology to recognize blood and other physical symptoms of illness and injury Basic nutrition and physical health care requirements Where to go or who to call in an emergency Administrator Pamela S. Hyde, JD 21

22 WHAT AMERICANS DON T KNOW Most Do Not Know and Are Not Taught: Signs of suicide, addiction or mental illness or what to do about them or how to find help for self or others Relationship of behavioral health to individual or community health or to health care costs Relationship of early childhood trauma to adult physical & mental/substance use disorders 43 WHAT AMERICANS BELIEVE percent believe treatment and support can help people with mental illness lead normal lives 20 percent feel persons with mental illness are dangerous to others Two thirds bli believe addiction can be prevented 75 percent believe recovery from addiction is possible 20 percent would think less of a friend/relative if they discovered that person is in recovery from an addiction 30 percent would think less of a person with a current addiction Administrator Pamela S. Hyde, JD 22

23 SO, HOW DO WE CREATE... A national dialogue on the role of BH in public life 45 With a public health approach that: Engages everyone general public, elected officials, schools, parents, community coalitions, churches, health professionals, researchers, persons directly affected by mental illness/addiction & their families Is based on facts, science, common understandings/messages Is focused on prevention (healthy communities) Is committed to the health of everyone (social inclusion) HELP US CHANGE THE CONVERSATION! 46 Administrator Pamela S. Hyde, JD 23