MHAScreening.org. The Strategy for Intervention B4Stage4. Paul Gionfriddo, President and CEO Mental Health America

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1 MHAScreening.org The Strategy for Intervention B4Stage4 Paul Gionfriddo, President and CEO Mental Health America

2 Presentation Outline Why Screen? Overview of the (Ongoing) Results. Examining Subpopulations. Breakdowns by Demographic Group Breakdowns by Co-Occurring Condition Local Data. Call to Action.

3 Why Screen? Screening Promotes Integration.

More Screening = Better Healthcare Screening in primary care perceived as helpful 93% of the time; PCPs 3 times more likely to recognize MI symptoms and follow up; Post-screening

4 More Screening = Better Healthcare Screening in primary care perceived as helpful 93% of the time; PCPs 3 times more likely to recognize MI symptoms and follow up; Post-screening treatment changes were made 40% of the time; Positive benefits persist one year later. Sources: Christensen, et al, 2005; Pignone et al, 2002; O Connor et al, 2009; Duffy et al, 2009.

5 Screening Promotes Recovery People who screen regularly are: More attuned to their symptoms; More knowledgeable about their conditions; Better able to communicate with their provider; Able to recognize improvement early in treatment; More aware of the warning signs of relapse; Better able to self-manage their illness.

6 MHA s B4Stage4 Prevention/Recovery Model: Where Screening Fits Recovery Prevention Integrated Care and Treatment Early Identification and Intervention

7 Intervention B4Stage 4: Why Screen?

8 MHA Online Screening Tools Depression (PHQ-9) Anxiety (GAD-7) Bipolar PTSD (PC-PTSD) Youth Screen (PSC-YR) Parent Screen (PSC) Alcohol and Substance Use Screen (CAGE-AID) Psychosis Screen (Ultra-High Risk) (PQ-B) Work Health Survey

9 Overview of the Ongoing Results. MHA Screening Links Early ID to Treatment and Recovery.

10 Overall Screening Numbers: Fast Facts Screening Web site: Number of Screening Tools Available: 9 % of Screens Started That are Completed: 90% Number of Screens completed: 650,000+ % Female: 74% % Under Age 25: 54% Current Monthly Average: 85,000 % Positive or Moderate-to-Severe (all conditions): 66% % Never Been Diagnosed (of everyone taking a screen): 67% 10

Screenings Completed, by Screen, Yr 1 58.9% 17.4% 18.0% 5.

11 Screenings Completed, by Screen, Yr % 17.4% 18.0% 5.7% Anxiety Screening Bipolar Screening Depression Screening PTSD Screening 11

12 Screening Summary Breakdown Male Negative Female 75% Positive 66% Non- White White 69% Never Been Diagnosed 65% Been Diagnosed Source:

13 Screeners, by Age 18% 8% 12% 5% 3% 1% 9% 5% 2% Inner Circle Apr 14-Apr 15 n= 242,204 50% 37% Outer Circle May-Jul 15 n= 116,054 "11-17" "18-24" "25-34" "35-44" "45-54" "55-64" 22% "65+" 28% 13

14 Screeners, by Race/Ethnicity 6.0% 7.2% Asian or Pacific Islander 10.2% Black or African American (non-hispanic) Hispanic or Latino 69.2% White, Non-Hispanic 4.2% 0.9% 2.2% More than one of the above Native American or American Indian Other White (non-hispanic) N=242,204 14

15 Screeners Income Distribution 35% 30% 25% 20% 15% 10% 5% 0% 15

16 Percent Positive* for Each Condition Positive Bipolar 9% Positive PTSD 6% Moderate Anxiety 7% Severe Anxiety 10% Severe Depression 25% Moderate Depression 19% Moderately Severe Depression 24% N=173,418 * Moderate to Severe = Positive 16

17 Almost All of Those Taking Psychosis Screening Are At Risk 5% Psychosis Risk No/Low Risk 95% N=2517, May-August,

18 Three-Fourths Likely for Substance Use Disorder 23% Likely Unlikely 77% N=2971, May-August,

19 What Will Screeners Do for Follow-up? Take a screen immediately Do nothing Take screens regularly Discuss with primary care doc Discuss with MH professional Discuss with a family or friend 0% 10% 20% 30% 40% 19

20 Support After Screening: What Screeners Want Find providers in my area 17% Other 9% More info about where to go for help 32% Online, selfhelp apps/tools 27% A way to contact a peer 15% N= 242,204 20

21 Word Cloud: What Do They Want? 21

22 Examining Subpopulations 1 Different Demographic Groups Yield Both Similar and Differing Results

23 Multi-Racial Individuals Most Positive or Moderate to Severe 72% 69% 74% 80% 77% 75% 74% 60% 72% N=242,204 23

24 Are People Who Self-ID as LGBT More Likely to Experience MH Concerns? LGBT General Population Source: CDC, % LGBT Screeners 20.3% N=79552, May August

25 Children and Mental Illness: Early Warning Signs Youth Screening 7% PTSD Screening 1% Depression Screening 70% Bipolar Screening 16% Anxiety Screening 6% 80.4% of youth taking youth screen were positive/at risk. Results of other screens not validated for youth. N=36,346 (May-July 2015). PTSD, SUD, and Parent Screens were <1% combined. 25

26 Children and Mental Illness: Even Earlier Warning Signs Parent Screening Results 38% 62% At Risk Not at Risk N=1616, May-August,

27 Young (<25) Women Slightly More Likely to have Positive Result 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Positive Young Women N=99654, May-August, 2015 Young Men Negative 27

28 Caregivers are Most Frequently Positive for PTSD and Depression 78.4% 71.3% 81.4% 81.9% 48.2% Alcohol or Anxiety Bipolar Depression PTSD Substance Use Screening N=6,303 (2015). 30% (versus 65% of overall screeners) were under 25; 14% (versus 1% of overall screeners) were

29 Vets/Active Duty: More Worried About Depression, Bipolar, Anxiety than PTSD Other PTSD Anxiety 79% Positive 68% Positive N=2855 Bipolar 49% Positive Depression 79% Positive Source: MHA Screening, May 2015-July

30 Who Has PTSD? % %+ 79%+ 82%+ 0 New Moms Vets Caregivers Students N=73,735. Note: Screeners could choose more than one category. 30

31 Race/Ethnicity: Blacks Most Likely to Do Something 45% Percent Saying Will Do Nothing with Results 43% 39% 35% 35% 35% 35% 36% 30% 31

32 Screening Results: Men More Likely to do Nothing 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Discuss results with family or friend Discuss results with MH professional Discuss results with PCP Take regular screens Do nothing Take another screen immediately 32 Female Male

33 Examining Subpopulations 2 Mental Illnesses Frequently Co-Occur with Other Conditions

Research Backdrop on Co-Occurring Conditions People with diabetes: 2x more likely to have depression. Adults with depression: 2x more likely to develop cardiovascular disease.

34 Research Backdrop on Co-Occurring Conditions People with diabetes: 2x more likely to have depression. Adults with depression: 2x more likely to develop cardiovascular disease. 25% of cancer patients also have major depressive disorder. 50% of people with chronic pain also have depression. 50% with depression also have anxiety disorder. Sources: NIH, VA, ADAA 34

35 14 Percent Have Other Chronic Conditions Co- Occurring 14% Migraines 1% Other 28% Pain 31% No Co- Occurring 86% Cancer 3% ADD/HD 3% Heart 8% Diabetes 13% Lung 13% Source: MHA Screening, May-August,

36 People Reporting Chronic Pain Who are Positive for a Mental Illness 23% Positive Negative 77% N=10353, May-August

37 People Reporting COPD/Lung Disease Who are Positive for a Mental Illness 20% 80% Positive Negative N=4150, May-August,

38 People Reporting Alzheimer s Who are Positive for a Mental Illness 25% Positive Negative 75% N=235, May-August,

39 People Reporting Diabetes Who Are Positive for a Mental Illness 26% 74% Positive Negative N=4162, May-August,

40 People Reporting Cancer History Who are Positive for a Mental Illness 29% Note: 63% positive for depression v. 25% with MDD in earlier research data. 71% Positive Negative N=935, May-August,

41 Local Results How Does Our Community Look?

42 Palm Beach County By the Numbers Total Number of Screeners (through August 2015): 648 Percent Female: 68% (versus 75% Florida and National) Most Common Screen: Depression (58% - Same as National) Roughly one in four PBC Screeners reports having at least one other chronic condition. 36% identify as students; 13% as LGBT; and 4% as caregivers. 42

43 PBC Screening Reaches a More Diverse Population White (non-hispanic) Other Native American or American Indian More than one of the above Hispanic or Latino PBC Florida National Black or African American (non-hispanic) Asian or Pacific Islander 0% 20% 40% 60% 80% 43

44 PBC Screeners are Older 40% 35% 30% 25% 20% 15% 10% 5% 0% "11-17" "18-24" "25-34" "35-44" "45-54" "55-64" "65+" National Florida PBC N= (National), May August,

45 Similar in Income, Slightly Wealthier 35% 30% 25% 20% 15% 10% 5% 0% National Florida PBC 45

46 Percent Positive, by Contribution to Total by Condition 80% 70% 60% 72% 73% 72% Positive PTSD Positive Bipolar 50% Severe Depression 40% 30% 20% 10% 0% National Florida PBC Moderately Severe Depression Moderate Depression Severe Anxiety Moderate Anxiety 46

47 Ever Been Diagnosed? No Yes 66.89% 67.49% 66.37% 33.11% 32.51% 33.63% National Florida PBC 47

48 People in PBC Most Likely to Report Having Co-Occurring Conditions 22% 28% 14% National Florida Palm Beach 48

49 Call To Action What We Can Do with the Results to Inform Policy and Practice.

50 What Young People (11-17) Say They Want 57% 46% 38% 10% 9% Phone Number Referral to Affiliates Worksheets Online Mobile Apps - track and manage symptoms Additional Information about mental health N=17969, May-July

51 What Caregivers Say They Want 54% 49% 41% 19% 26% Phone Number Referral to Affiliates Worksheets Online Mobile Apps - track and manage symptoms Additional Information about mental health N=4085, May-July,

52 What Active Duty/Veterans Say They Want 48% 42% 42% 19% 22% Phone Number Referral to Affiliates Worksheets Online Mobile Apps - track and manage symptoms Additional Information about mental health N=1491, May-July,

53 Different Demo Groups Want Different Things, But Everyone Wants Online Help and Info 40% 35% 30% 25% 20% 15% 10% 5% 0% Online, Self Help Apps Contact a Peer Info about where to get MH help Help Find Providers Other (please specify) 53

54 PBC Residents Want More Help Finding Treatment 35% 30% 25% 20% 15% 10% 5% National Florida PBC 0% Discuss results with family, friend or pro Find additional information online Find treatment Monitor my Do Nothing health 54

55 Screeners in PBC Want a More Personal Touch Helpline and Affiliate Connection 60% 50% 40% 30% 20% 10% National Florida PBC 0% Phone # for immediate assistance Referral to Affiliate Worksheets or Coping Skills to use at home Online Mobile Apps - track and manage symptoms More Info about MH 55

56 MHA s Advocacy for Screening Mental health screening should be as commonplace as vision, hearing, dental, and blood pressure screening. It should be conducted in clinicians offices, communities, schools, and workplaces. Revision of the Free Care Rule (December 2014) makes free screening in schools reimbursable by Medicaid. 56

57 MHA s Screening to Treatment and Recovery Online Screening S2T Apps and Interactive Web Environment Clinical Tools and Worksheets Referrals to Affiliates Paid MHA apps. Vendor Opportunities Improved, Linked Web Content Helplines; Local and Peer Support 57

58 Using Screening Results for Education and Evaluation Online Screening Special URLs for Population Tracking Regular and Special Reports Informing Policy and Practice 58

59 Thank You!

Personal Information. Full Name: Address: Primary Phone: Yes No Provider Yes No. Alternate Phone: Yes No Provider Yes No

Personal Information. Full Name: Address: Primary Phone: Yes No Provider Yes No. Alternate Phone: Yes No Provider Yes No OFFICE USE ONLY: Date of Intake: ID#: Staff mbr: Personal Information Full Name: Address: _ Last First M.I. Street Address Apartment/Unit # City State Zip Code County Date of Birth: Age: Mobile phone?