Fighting Stigma Through Social Inclusion and a Whole Person Approach to Wellness American Psychiatric Nurses Association 26 th Annual Conference Pittsburgh, PA November 9, 2012 Wilma Townsend, M.S.W. Acting Director Center for Mental Health Services, Office of Consumer Affairs Substance Abuse and Mental Health Services Administration Beverly Gallauresi, M.P.H., RN Senior Nurse Advisor and Health Programs Coordinator Research and Development Team, Office of Women s Health U.S. Food and Drug Administration Townsend, Gallauresi 1
Disclosure The presenters have no conflicts of interest to disclose. 4 Presentation Objectives Attendees will be able to: Define social inclusion and its crucial relation to decreasing stigma against individuals with mental health and substance use disorders. Explain early mortality factors and proactive wellness strategies, policies, initiatives, and activities applicable to a wide array of individual, professional, organizational, and community behavioral health settings. Identify how pregnant women who have mental health and substance use disorders can continue their wellness journeys and fight stigma. 5 Prevalence of Mental Health and Substance Use Disorders Stigma can arise when people are uninformed they often don't realize that mental health and substance use disorders are very common. More than a quarter of Americans ages 18 years or older suffer from a diagnosable mental disorder in a given year. 1 Nearly half of the U.S. adult population will experience some mental disorder in their lifetime. 2 1 Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12 month DSM IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617 627. 2 Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age of onset distributions of DSM IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593 602. 6 Townsend, Gallauresi 2
Reducing Early Mortality Through Wellness People with mental health and substance use disorders die decades earlier than the general population. By pursuing wellness, we can reduce the disparity in mortality. Source: Measurement of Health Status for People with Mental Illnesses, National Association of State Mental Health Program Directors (NASMHPD), 2008. 7 Early Mortality Factors Factors Contributing to Preventable, Premature Death: Large number of deaths from cardiovascular disease; Higher rates of diabetes, obesity, asthma, arthritis, epilepsy, and cancer; Lack of comprehensive primary and behavioral health care, or traumainformed care; Modifiable risk behaviors (e.g., smoking, poor nutrition, inactivity, substance use, lack of sleep); Higher rates of poverty, homelessness, unemployment, incarceration; Side effects of psychotropic medications; and Social isolation, trauma, stigma, and discrimination. Source: Parks, J., Svendsen, D., Singer, P., & M. E. Foti, eds. (2006). Morbidity and Mortality in People with Serious Mental Illness, p. 14 15. Alexandria, VA: NASMHPD. Retrieved from http://www.dsamh.utah.gov/docs/mortality morbidity_nasmhpd.pdf 8 Early Mortality Factors Smoking Related Statistics: 75 percent of individuals with either mental or substance use disorders smoke cigarettes, as compared to 23 percent of the general population. 3 Americans with mental health problems represent an estimated 44.3 percent of the U.S. tobacco market. Half of all deaths from smoking occur among patients with mental or substance use disorders. 3 Parks, J., Svendsen, D., Singer, P., & M. E. Foti, eds. (2006). Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA: NASMHPD. Retrieved from http://www.dsamh.utah.gov/docs/mortality morbidity_nasmhpd.pdf 9 Townsend, Gallauresi 3
Early Mortality Factors Poverty Statistics: 31.7 percent of people with mental health problems live below the poverty line. 4 72 percent of people with mental health problems are unemployed. 5 Approximately 46 percent of people who are homeless have a mental illness. 6 4 Erickson, W., & Lee, C. (2008). 2007 Disability Status Report: United States. Ithaca, NY: Cornell University Rehabilitation Research and Training Center on Disability Demographics and Statistics. 5 Ibid. 6 The President s New Freedom Commission on Mental Health. (2004). The State of American Mental Health Care: Where Have We Been, What Have We Done, and Where Are We Going? 10 10 What Is Recovery? The process in which people are able to live, work, learn and participate fully in their communities For some individuals, the ability to live a fulfilling and productive life despite disability For others, implies the reduction or complete remission of symptoms Science shows that having hope plays an integral role in an individual s recovery. 11 11 What Is Wellness? Wellness is not the absence of disease, illness, and stress, but the presence of 7 : Purpose in life Active involvement in satisfying work and play Joyful relationships A healthy body and living environment Happiness 7 Dunn, H. L. (1961). High Level Wellness, Beatty Press: Arlington, VA 12 Townsend, Gallauresi 4
The Eight Dimensions of Wellness Adapted from Swarbrick, M. (2006). A wellness approach. Psychiatric Rehabilitation Journal, 29(4), 311 314. 13 National Prevention Strategy Seven Priorities: 1) Tobacco free living 2) Preventing drug use and excessive alcohol use 3) Healthy eating 4) Active living 5) Mental and emotional well being 6) Reproductive and sexual health 7) Violence free living 14 SAMHSA s Wellness Objectives To raise awareness that people with mental health and substance use disorders die decades earlier than the general population To promote ways to improve health behaviors and incorporate the Eight Dimensions of Wellness into recovery To motivate action to incorporate wellness as a means to enhance quality of life while increasing years of life 15 Townsend, Gallauresi 5
Impact of Affordable Care Act Major drivers: More people will have insurance coverage. Medicaid will play a bigger role in mental and substance use disorders than ever before. There will be a greater focus on coordination between primary care and specialty care. A major emphasis is on home and community based services and less reliance on institutional care. Preventing diseases and promoting wellness is a huge theme. 16 Affordable Care Act and Primary Care Integration Why is integration so important? 12 million visits annually to ERs by people with mental and substance use disorders 70 percent had at least one chronic health condition 45 percent have two chronic conditions Nearly 30 percent have three or more chronic conditions Integration and acknowledgment by all health sectors can help educate and therefore lessen stigma 17 Partners and Champions SAMHSA s Interagency Partner for Wellness U.S. Food and Drug Administration s Office of Women s Health Wellness Champions Wellness National Steering Committee More than 2,300+ individuals and community based organizations National organizations including: National Council for Community Behavioral Healthcare, 56 SAMHSA Primary and Behavioral Health Care Integration Grantees, Faces and Voices of Recovery, Centers for Disease Control and Prevention, Healthy People 2020, Mental Health America, National Alliance on Mental Illness, National Coalition for Mental Health Recovery, National Association of State Mental Health Program Directors, and many more 18 Townsend, Gallauresi 6
Community Outreach As part of National Recovery Month, we hosted National Wellness Week (September 17 23, 2012) with these calls to action: To inspire individuals to improve one physical health behavior and incorporate the Eight Dimensions of Wellness into their everyday lives To join with thousands of others on Wednesday, September 19, in a Creative Expression for Wellness and Friday, September 21, in a Line Dance for Wellness To promote wellness in their community during National Wellness Week or better yet, all year round 19 Wellness Tools http://store.samhsa.gov Wellness posters, brochures Informational teleconferences Web sites: http://www.samhsa.gov/wellness http://www.fda.gov/womens http://www.cdc.gov/mentalhealth/about_us/m icd.htm http://www.thenationalcouncil.org/cs/center_f or_integrated_health_solutions 20 Pregnancy Exposure Registry Web site Beverly Gallauresi, M.P.H., RN November 9, 2012 21 Townsend, Gallauresi 7
About FDA The oldest consumer protection agency in the U.S. Ensures that regulated products are safe and effective. 22 What FDA Regulates FOODS HUMAN DRUGS BIOLOGICS COSMETICS 23 What FDA Regulates, Cont d Medical Devices and Radiological Health Animal Drugs, Feed, and Testing Tobacco Products 24 Townsend, Gallauresi 8
Why Does FDA Have an Office of Women s Health? The FDA needs to ensure more study of gender differences in prescription drug testing. Women were not adequately included in clinical studies Lack of understanding of sex/gender differences 25 FDA Office of Women s Health (OWH) Created in 1994 by Congressional mandate Mission Protect and advance the health of women through policy, science, and outreach Advocate for inclusion of women in clinical trials and analysis of sex/gender effects 26 Understanding Medication Use in Pregnancy Most pregnant women are excluded from clinical research 64 percent of women are prescribed one or more drugs during pregnancy Little clinical data available to evaluate safety and efficacy of drug use in pregnant women and fetal exposure 27 Townsend, Gallauresi 9
Behavioral Health and Pregnancy Some health care providers advise their patients on selective serotonin re uptake inhibitors (SSRI): Don t get pregnant If they get pregnant stop taking your medications! 28 Behavioral Health and Pregnancy Although the FDA does not regulate the practice of medicine, the thought process is: Healthy Mom = Healthy Baby Pregnancy Registries results can help pregnant women make better informed decisions. 29 What Is a Pregnancy Exposure Registry? A study conducted by a drug company that collects observational data from women taking prescription medications/vaccines while pregnant Also collects information on newborns 30 Townsend, Gallauresi 10
Benefits of Using a Registry Short Term No immediate gratification not a quick fix Long Term Provides pregnancy and fetal outcomes data Data may be used to improve product labeling Better informs pregnant women about risks and benefits of prescription drug use 31 OWH Pregnancy Exposure Registry Web Site Information Defines pregnancy registries Useful to health professionals, consumers Offers a compendium of all available registries Facilitates registry enrollment 32 Criteria for Registry Listing Each registry is a post marketing requirement Sponsors or research institutions may request to list a registry on the web site However, all registries must be reviewed by Center for Drug Evaluation and Research (CDER) or Center for Biologics Evaluation and Research (CBER) to ensure scientific integrity 33 Townsend, Gallauresi 11
Exposure Registries Listed 65 registries currently listed (8/23/2012) Organization: Registries specific to a medication Registries for specific diseases Asthma Autoimmune disease Cancer Diabetes Epilepsy HIV/AIDS Organ transplant 34 Recent Updates Focus group testing for usability and content Conducted February 2011 Health care professionals Physicians, nurses, pharmacists Consumers Women 18 49, pregnant, recently pregnant or considering pregnancy 35 Pregnancy Registries on FDA OWH Web Site http://www.fda.gov/scienceresearch/specialtopics/womenshealthresearch/ucm251314.htm 36 Townsend, Gallauresi 12
How to Sign Up for Pregnancy Registries on FDA OWH Web Site http://www.fda.gov/scienceresearch/specialtopics/womenshealthresearch/ucm252397.htm 37 List of Pregnancy Registries on FDA OWH Web Site http://www.fda.gov/scienceresearch/specialtopics/womenshealthresearch/ucm134848.htm 38 For More Information FDA Office of Women s Health http://www.fda.gov/aboutfda/centersoffices/oc/officeof WomensHealth/default.htm 301 796 9441 Organization of Teratology Information Specialists (OTIS) http://www.otispregnancy.org Live counselors to take your call and give you information regarding your pregnancy and medication questions 866 626 6827 39 Townsend, Gallauresi 13
Contact Information Wilma Townsend, M.S.W. Acting Director Center for Mental Health Services, Office of Consumer Affairs Substance Abuse and Mental Health Administration 240 276 1948 wilma.townsend@samhsa.hhs.gov Beverly Gallauresi, M.P.H., RN Senior Nurse Advisor and Health Programs Coordinator Research and Development Team, Office of Women s Health U.S. Food and Drug Administration 301 796 9438 Beverly.Gallauresi@fda.hhs.gov 40 Townsend, Gallauresi 14