Community Health Needs Assessment Mental Health Profile

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1 Community Health Needs Assessment Mental Health Profile April 5, 2018 Jeanne Ang, MCRP Advocate Health Care Director of Community Health, North Region

2 Community Health Needs Assessment (CHNA) As part of the Internal Revenue Service (IRS) requirement as a nonprofit organization, every three years each Advocate Health System hospital is required to conduct a community health needs assessment (CHNA) of its service area CHNA conducted in 2016 covering the period of The goal is to identify the highest need health issues within the Advocate Good Shepherd Hospital service area Cardiovascular Disease Diabetes Obesity Cancer Mental Health Substance Abuse

4 Mental Health Expenditures By State, 2013 Kaiser Family Foundation, 4

5 Mental Illness Statistics For Children & Teens 75% of chronic mental illness begins by age 24 ~ most (50%) by age 14. Half of kids that need mental health care don t receive it. Adolescents (2-17 years old) usually struggle for years before getting help. Adolescents (2-17 years old) who don t get help often get into trouble with family, school and/or police. 90% of those who die by suicide have mental illness - 2 nd leading cause of death in kids. Source: NAMI (National Alliance on Mental Illness)

Age Adjusted ER Rate due to Pediatric Mental Health County Comparison 62.0 63.2 64.1 70.

6 Age Adjusted ER Rate due to Pediatric Mental Health County Comparison Source: Illinois Hospital Association, , updated January 2018.

7 Age-Adjusted ER Rate due to Pediatric Mental Health Lake County 64.1 ER visits/10,000 population under 18 years McHenry County 63.2 ER visits/10,000 population under 18 years 54.0 ER visits = = 74.9 ER visits 57.9 ER visits = = 68.7 ER visits Source: Illinois Hospital Association , updated January 2018.

8 Age-Adjusted ER Rate due to Pediatric Mental Health Good Shepherd Hospital Primary Service Area (PSA) 50.2 ER visits/10,000 population under 18 years 47.6 ER visits = = 52.9 ER visits Source: Illinois Hospital Association , updated January 2018.

9 Age Adjusted ER Rate due to Pediatric Mental Health Top Zip Codes Lake County (Worst Quartile)* Lake Villa 87.4/10, Waukegan 87.4/10, Ingleside 90.3/10, Zion 92.7/10, Highwood 113.0/10,000 McHenry County (Worst Quartile)* Marengo 87.8/10, Wonder Lake 100.8/10, McHenry 103.2/10,000 *When compared to other zip codes in Illinois *When compared to other zip codes in Illinois Source: Illinois Hospital Association, , updated January 2018.

10 Adult

Age Adjusted ER Rate due to Mental Health - Adults County Comparison 65.5 74.3 85.1 91.

11 Age Adjusted ER Rate due to Mental Health - Adults County Comparison Source: Illinois Hospital Association, , updated January 2018.

12 Age-Adjusted ER Rate due to Mental Health - Adults Lake County 74.3 ER visits/ 10,000 population over 18 years McHenry County 93.3 ER visits/ 10,000 population over 18 years 69.1 ER visits = = 79.6 ER visits 88.7 ER visits = = 97.5 ER visits Source: Illinois Hospital Association, , updated January 2018.

13 Age-Adjusted ER Rate due to Mental Health Adults Good Shepherd Hospital Primary Service Area (PSA) 72.1 ER visits/10,000 population over 18 years 68.4 ER visits = = 75.5 ER visits Source: Illinois Hospital Association , updated Jan 2018.

14 Age Adjusted ER Rate due to Mental Health - Adults Top Zip Codes Lake County (Worst Quartile)* Lake Villa 87.4/10, Waukegan 87.4/10, Ingleside 90.3/10, Zion 92.7/10, Highwood 113.0/10,000 McHenry County (Worst Quartile)* Richmond 122.5/10, Hebron 123.7/10, McHenry 126.1/10, Wonder Lake 149.3/10,000 *When compared to other zip codes in Illinois *When compared to other zip codes in Illinois Source: Illinois Hospital Association, , updated January 2018.

Source: County Health Rankings 2015, April 2017; and Centers for Medicare and Medicaid Services, 2015, updated March 2017.

mental health, which includes stress, depression, and problems with emotions, was not good for 14 or more of the past 30 days.

15 Source: County Health Rankings 2015, April 2017; and Centers for Medicare and Medicaid Services, 2015, updated March Mental Distress and Poor Mental Health Days Frequent Mental Distress This indicator shows the percentage of adults who stated that their mental health, which includes stress, depression, and problems with emotions, was not good for 14 or more of the past 30 days. Poor Mental Health Days This indicator shows the average number of days that adults reported their mental health was not good in the past 30 days 9.4% 9.5% 3.3 days 3.3 days

16 Depression: Medicare Population The percentage of Medicare beneficiaries who were treated for depression. 13.1% 14.7 % Lake County McHenry County Source: Centers for Medicare and Medicaid Services 2015, updated March 2017.

17 Your Zip Code Influences Your Health Source: Centers for Disease Control and Prevention, 2017.

Highest SocioNeeds index Zion Waukegan North

Unemployment Occupation Education Language

18 Highest SocioNeeds index Zion Waukegan North Chicago Lake County SocioNeeds Index Map Next highest Highwood Fox Lake Ingleside Round Lake Calculated from 6 indicators: Poverty Income Unemployment Occupation Education Language Source: Nielsen Claritas, Healthy Communities Institute, 2016

Wauconda Calculated from 6 indicators: Poverty Income Unemployment

19 Good Shepherd Medical Center SocioNeeds Index Map Highest SocioNeeds index McHenry(60050) Island Lake Next highest are McHenry (60051) Wauconda Calculated from 6 indicators: Poverty Income Unemployment Occupation Education Language Source: Nielsen Claritas, Healthy Communities Institute,

20 2017 Healthier Barrington Study Manorama M. Khare, PhD, MS Research Assistant Professor; Associate Director, Evaluation and Community Research; University of Illinois College of Medicine Rockford 3

21 Overall Study Goals To understand the overall health of the Barrington region, including physical, mental and behavioral health To identify: o Community values, priorities and perceptions o Gaps and unmet needs o Economic conditions o Best methods to reach community members 4

22 Methodology Community Analysis Survey o Dual method web/paper o Convenience sample Focus Groups o Content informed by preliminary survey results o Included consumers, caregivers, parents, and providers 5

23 2017 Healthier Barrington Study SURVEY RESULTS: BEHAVIORAL AND MENTAL HEALTH 37

24 Seeking Services for Behavioral or Mental Health Issues Did anyone in your household think about seeking professional help for a behavioral or mental health issue? 37.8% (132/349) Did anyone actually seek help? 28.8% (38/132) of these respondents reported that they did not actually seek it Common reasons for not seeking help were: o Financial Concerns (14/61) o Didn t know where to go (11/61) o Other (8/61) Did not think it would help the situation Better options than professional help It was not so bad 32

25 Health Care Coverage, Cost, & Availability 96.0% (or 359/374) of households had medical insurance Delaying Care 17.2% (or 35/203) reported delaying behavioral or mental health care services in the past year o A majority (71.4% or 25/35) delayed care due to costs o 28.6% (10/35) delayed care due to availability of services 32

26 Other Behavioral or Mental Health Issues: Suicide To the best of your knowledge, have you or any members of your household seriously considered or made plans for suicide during the past year? Yes - 2.5% (9/359) No % (340/359) Maybe - 2.8% (10/359) 40

27 Other Behavioral or Mental Health Issues: Abuse 87.5% (300/343) of respondents reported no abuse of anyone in their household 12.5% (43/343) of households reported abuse in the past year, 62.7% (27/43) reported emotional abuse 27

28 Youth Issues Which of the following, if any, are issues for persons under 18 in your household? (Options were: Aggressive/violent behavior, Alcohol use, Anxiety, ADD/ADHD, Autism, Bullying, Depression, Drug abuse, Eating disorders, Pressure to succeed, Learning disabilities, Negative peer pressure, Obesity, Overscheduled, Pressure to be thin, Serious school related problems, Sleep deprivation, Uncontrolled anger, No problems) 148 respondents selected 294 options (multiple issues could be checked) 42

29 29

30 2017 Healthier Barrington Study FOCUS GROUPS Mental Health and Substance Abuse in Youth and Adults 46

31 Purpose of Focus Groups To understand behavioral health (mental health and substance abuse) needs of adults and youth in the community To identify barriers to receiving available mental health and substance abuse services for both adults and youth To identify services most needed to address behavioral health issues in the community 47

32 Methods A semi-structured focus group guide was developed in both English and Spanish Focus groups were conducted by trained focus group moderators o 3 focus groups 2 parent/caregiver groups (1 in English, 1 in Spanish) 1 provider group (English) Recruitment was done through local agencies Participants provided consent and completed a demographic form Discussion was recorded and transcribed 48

33 Focus Group Questions Major mental health/substance abuse issues affecting adults and youth Barriers to care for mental health / substance abuse for adults and youth Resources available in the community for mental health care / substance abuse care for adults and youth Services most needed 49

34 Participant Characteristics Total Number of Participants: 23 Mean age: 48.3 ± 12.1 years Gender: 83% female, 17% male 61% White 25% American Indian, Asian, Other 13% No response Role: 78% parent/caregiver; 22% provider 51

35 Participant Characteristics EDUCATION 17% MARITAL STATUS 17% 26% 9% 48% 9% 74% Bachelor's Degree or Higher Associates Degree or Some College High School Graduate/GED Some High School Married Unmarried, Living with Partner Unmarried, Not Living with Partner 52

36 Participant Characteristics ANNUAL HOUSEHOLD INCOME >$75, EMPLOYMENT STATUS 4% 4% $50,001-75, % $35,001-50, % 65% $15,001-35, <$15, Percent of Respondents (n=22) Work Full-Time Part-Time Homemaker Unemployed Other (Contractor) 53

37 Mental Health Issues Faced by Adults and Youth ADHD (youth) Anxiety (youth) Bipolar Depression Schizophrenia Stress Suicide 54

38 Types of Substances Abused by Adults and Youth Alcohol Cocaine Marijuana Heroin; laced into other drugs 57

39 Barriers to Mental Health & Substance Abuse Care Stigma associated with accessing care / Cultural influences I think what I experience the most is the stigma around getting services. Once people come that s a whole different story. Stigma is generational I think it s generational. The level of acceptance and the greatest denial would be with our older population. I think the openness to accepting help is greater as we get into younger generations. Stigma is less for substance abuse than for mental health Stigma is not as bad as mental health, no Parental Denial / Lack of Acceptance I think that s one of the barriers to getting kids the treatment they need. We do have smart kids who come for treatment prior Without their parents knowing, just because, I need help. They know that from school, so they ll just walk over to get some support and some help and treatment. That s not all of them. 55

40 Barriers to Mental Health & Substance Abuse Care Lack of (Crisis Intervention Team) CIT trained officers "There are models in other states where they are training EMT people as well as law enforcement beyond CIT training, more intense training to do just that, the triage. Barrington does not have their paramedics CIT trained yet maybe the police, but paramedics absolutely need it. Lack of Supportive Housing & Transportation I think the biggest issue that most families face is supportive housing. There is nowhere for a young person who suffers from schizophrenia There is absolutely nowhere to put them and there s really no help. 56

41 Barriers to Mental Health & Substance Abuse Care Lack of information/resources or information not accessible (language, resources) Most of it, I believe it is our culture, the Hispanic culture. We have come forward about many things but talking about depression still a taboo... Ease of access of alcohol and drugs within the school also I think schools have to get a handle on the pot. Every kid there is on pot and they just turn their head. They don t want to deal with it. They should be testing the athletes, they should be doing something. 41

42 Barriers to Mental Health & Substance Abuse Care Financial limitations Some of the psychiatrists are requesting money up front. Not even insurance. Then they ll help you with the paperwork with the insurance but you ve got to do the insurance. Who s got that kind of money? What s even worse is insurance companies give it (substance abuse treatment) a priority over mental health. It s been my experience Lack of treatment and recovery programs within close proximity 56

43 Resources Currently Available Rosecrance in Rockford for substance abuse Northwest Community Hospital Alexian Brothers Behavioral Health Inpatient Facility Samaritan Barrington Behavioral Health Vista West at Waukegan Website of Barrington area mental health and substance abuse resources AA for Alcohol Abuse Kaleidoscope Awakenings Project Art therapy 59

44 Advocate Good Shepherd Hospital Mental Health Strategies and Interventions 1. Reduce the stigma of mental health Mental Health First Aid training (Teachers, Coaches, PE Teachers, Seniors) (First Responders) Mental Health 2. Increase the number of adults in the Primary Service Area (PSA) who are screened for depression and referred to mental health services PHQ2 and PHQ9 Depression Screening (Adults and Seniors) 3. Strengthen Good Shepherd Hospital s linkages to community health agencies within the service area Mental Health Resource Fair May 12 (Adults) 44

45 Recommendations from Participants An Integrated Approach to Care Trauma Informed Care Access to a Navigator / Case Management Professional Overall Education and Awareness about Mental Health and Substance Abuse Support services in schools Early intervention middle school and even elementary schools The Living Room model a community crisis respite center to be used as an alternative to the ER Accessible Supportive Housing Peer Group activities 61

Questions? Contact: Jeanne Ang, Community Health Director, North Region jeanne.ang@advocatehealth.

46 Questions? Contact: Jeanne Ang, Community Health Director, North Region Phone Manorama Khare, Research Assistant Professor, Associate Director Community and Evaluation Research, UIC College of Medicine, Rockford

Community Needs Assessment. June 26, 2013

Community Needs Assessment. June 26, 2013 Community Needs Assessment June 26, 2013 Agenda Purpose Methodology for Collecting Data Geographic Area Demographic Information Community Health Data Prevalence of Alcohol & Drug Use Utilization data Findings