Transcript The State of Mental Health in Guilford County

A presentation to the
Moses Cone-Wesley Long
Community Health Foundation
April 29, 2010
Kelly N. Graves, PhD
Anne Buford, MPA, NCC, LPC
Sonja Frison, PhD, MPH
Amanda Ireland, MA
Terri L. Shelton, PhD
Acknowledgements
 Erin Balkind
 Anderson Bean
 Korinne Chiu
 Frederick Douglas
 Kelley Richardson
 Megan Smell
 Claretta Witherspoon
 All the youth, families, providers, and agencies that
assisted or participated in surveys and focus groups
Mental Health as a Priority
 One of the nation’s top public health priorities
 Healthy People 2010 and 2020 mental health-related goals:
 Increase treatment access and engagement among various populations
 Reduce suicide attempts and completions
 Utilize consumer satisfaction measures
 Increase mental health services and referrals at primary care locations
 The World Health Organization (WHO, 2001, p. 1) noted that “mental
health is as important as physical health to the overall well-being of
individuals, societies and countries.”
 Mental health is connected to physical health, quality of life,
community well-being
 Important to treat mental illness and promote mental health
 Mental health as a continuum
Herrman, Saxena, Moodie, & Walker, 2005; Keyes, 2007; U.S. DHHS, 2000, 2001, 2009
Methodological Approach
 Review of national, state, and local data/trends
 Including preliminary examination of resources/gaps
 Implementation of participatory action research
framework:
 Six focus groups
 Nine key informant interviews
 Online community survey, conducted through snowball
sampling (N = 206)
 Feedback from community forums
Scope of the Problem
 According to the 2008 National Survey on Drug Use and Health:
 Approximately 10 million adults in U.S. experienced serious mental
illness in previous year (4.4% of adult population)
 Highest rates among those 18-25 years old, women, persons of more
than one race, the unemployed
 According to averages of the 2005 and 2006 National Survey on
Drug Use and Health:
 Approximately 743,000 adults in NC experienced serious
psychological distress in previous year (11.6% of adult population)
 Approximately 474,000 adults in NC experienced at least one major
depressive episode in previous year (7.4% of adult population)
 Approximately 60,000 children/adolescents in NC experienced at
least one major depressive episode in previous year (8.4% of
child/adolescent population)
Hughes, Sathe, & Spagnola, 2008; SAMHSA Office of Applied Studies, 2009
Selected Results from NC-TOPPS Initial Interviews: July 2008 – June 2009
Child Mental Health Consumers, Ages 6 to 11 (N=366; 61% Male, 39% Female)
Guilford LME – Quality Management Team, NCDMHDDSAS
DSM-IV Diagnosis
% Identified – Guilford LME
% Identified - Statewide
Attention deficit disorder
Oppositional defiant disorder
Adjustment disorder(s)
Severity of Mental Health Symptoms, Past Month
None or mild
Moderate
Severe or very severe
Behavior Symptoms and Abuse, Past 3 Months
Suicide attempts
Suicidal thoughts
Attempted self-injury
Physical injury to another person
Physically abused
Problem Interference with School/Daily Activities
None
A few times
More than a few times
46%
31%
17%
% Identified – Guilford LME
12%
60%
27%
% Identified – Guilford LME
2%
8%
6%
48%
29%
% Identified – Guilford LME
5%
46%
48%
% Identified “Fair” or “Poor”
– Guilford LME
22%
80%
72%
53%
33%
16%
% Identified - Statewide
16%
54%
30%
% Identified - Statewide
2%
13%
9%
58%
36%
% Identified - Statewide
5%
44%
50%
% Identified “Fair” or “Poor”
- Statewide
21%
76%
65%
Quality of Life Rating
Physical health
Emotional well-being
Family relationships
Selected Results from NC-TOPPS Initial Interviews: July 2008 – June 2009
Adolescent Mental Health Consumers, Ages 12 to 17 (N=595; 59% male, 41% female)
Guilford LME – Quality Management Team, NCDMHDDSAS
DSM-IV Diagnosis
Attention deficit disorder
Oppositional defiant disorder
Conduct disorder
Severity of Mental Health Symptoms, Past Month
None or mild
Moderate
Severe or very severe
Behavior Symptoms and Abuse
Suicide attempts in lifetime
Suicidal thoughts in past 3 months
Attempted self-injury/Self-injury
Physical injury to another person
Physically abused in past 3 months
Problem Interference with Work/School/Daily
Activities,
Past 3 Months
None
A few times
More than a few times
Quality of Life Rating
Physical health
Emotional well-being
Family relationships
% Identified – Guilford LME
35%
39%
19%
% Identified – Guilford LME
25%
46%
28%
% Identified – Guilford LME
11%
14%
49%
9%
30%
% Identified - Statewide
34%
41%
15%
% Identified – Statewide
24%
50%
26%
% Identified – Statewide
10%
18%
45%
11%
29%
% Identified – Guilford LME
% Identified – Statewide
10%
43%
7%
43%
47%
49%
% Identified “Fair” or “Poor” % Identified “Fair” or “Poor”
– Guilford LME
– Statewide
24%
24%
71%
71%
72%
70%
Selected Results from NC-TOPPS Initial Interviews: July 2008 – June 2009
Adult Mental Health Consumers, Ages 18 and Older (N=903; 42% male, 58% female)
Guilford LME – Quality Management Team, NCDMHDDSAS
DSM-IV Diagnosis
Major depression
Schizophrenia
Bipolar disorder
Severity of Mental Health Symptoms, Past Month
None or mild
Moderate
Severe or very severe
Behavior Symptoms and Violence
Suicide attempts in lifetime
Suicidal thoughts
Attempted self-injury
Physical injury to another person
Physical violence in past 3 months
Problem Interference with Work/School/Daily
Activities,
Past 3 Months
None
A few times
More than a few times
Quality of Life Rating
Physical health
Emotional well-being
Family relationships
% Identified – Guilford LME
34%
23%
24%
% Identified – Guilford LME
13%
49%
38%
% Identified – Guilford LME
28%
32%
9%
17%
15%
% Identified - Statewide
42%
21%
24%
% Identified – Statewide
14%
44%
41%
% Identified – Statewide
35%
37%
12%
13%
12%
% Identified – Guilford LME
% Identified – Statewide
6%
8%
28%
30%
66%
59%
% Identified “Fair” or “Poor” % Identified “Fair” or “Poor”
– Guilford LME
– Statewide
66%
65%
87%
85%
77%
70%
Health Disparities
 Socioeconomic Level – Serious psychological stress and poverty
 Race/ethnicity –
 Prevalence - 30% more often among African American adults than
non-Hispanic White adults
 Symptoms - Suicide attempt rates found to be almost twice as high
among Hispanic adolescents (grades 9-12) as compared to nonHispanic White adolescents
 Access / Receipt of Services - Non-Hispanic White adults more
often connected with mental health services (14%) than nonHispanic Black adults (7.4%), Hispanic adults (7.0%), American
Indian/Alaskan Native adults (10.7%), and Asian American adults
(5.6%)
Special Populations
 Co-Occurring Disorders – estimates range widely in
NC from 2%-68%
 Homeless individuals – between 20%-40% are both
mentally ill and without a home (1.4 million people in
US)
 Point in time counts of homeless in Guilford – 1,064
(23% are children)
 Adolescent parents – 57% report mental health
symptoms, increased substance use
 Guilford County 2008 – 966 girls between 15-19 years (3
teens each day)
Special Populations
 Immigrant Populations – estimates vary widely, but
access, language and culture, and stigma prevent
treatment in many cases
 Adult and juvenile justice – estimates vary widely
(40%-90%), higher for females
 “criminalization of the mentally ill”
 College Populations – First time seeking services and
diagnosis for many
 All eight colleges and universities have a counseling
center and/or offer some counseling services for
students, with at least crisis intervention, assessment,
and/or short term counseling
Special Populations
 HIV/AIDS – majority have 2 or more psychiatric
diagnoses, 81% report substance use
 Impacts medication adherence and increased risk for
suicidal behaviors
 Elderly – 22% of population
 Older, Caucasian males have highest rates of suicide in
US
 Reductions in social contact, self-worth, and pain and
frustration around physical illness
NC’s Report Card
 National Alliance on Mental Illness (NAMI) – Grading the
States: A Report on America’s Health Care System for
Adults with Serious Mental Illness
 2006 – NC received a grade of D+. Evaluation elements
included: infrastructure (C-); information access (D);
services (D); and recovery supports (B+)
 2009 – NC received a grade of D. Evaluation elements
included: health promotion/measurement (D);
financing and core treatment/recovery services (C);
consumer/family empowerment (F); and community
integration/ social inclusion (C).
Treated Prevalence
 Treated prevalence rates for persons with mental illness vary
widely
 Treated prevalence = persons estimated to have mental health
conditions needing services who actually receive services for
their mental health conditions
Clinical Population
Estimated
to be in
Need
Persons Served
Percentage
Served
Guilford
Percentage
Served
State
Adults with MH
19,728
8,929
45%
48%
Children/Adolescents
with MH
11,135
4,871
44%
49%
Quality Management Team, NCDMHDDSAS, 2010
Costs of Mental Illness
 Costs are direct and indirect. They include:
 Treatment, disability, unemployment, incarceration,
homelessness, substance abuse, suicide
 According to the 2009 Medical Expenditure Panel Survey:
 Mental disorders accounted for greatest rise in medical
expenses between 1996 and 2006 (from $35.2 billion to $57.5
billion in adjusted figures)
 Census of persons with mental health expense outlays grew
from 19.3 million to 36.2 million across same time period
 Researchers estimate roughly $193 billion in income lost each
year due to mental illness (estimates were from early part of the
decade; these may be underestimates by today’s costs)
 Researchers link untreated mental illness to:
 Chronic diseases, risky health-related behaviors, violence,
work absenteeism
AHRQ, 2009; CDC, n.d.; Kessler et al., 2008; NAMI, n.d.
Costs of Mental Illness
 According to the NC State Center for Health Statistics:
 3,377 persons in NC died due to a mental health or substance
abuse diagnosis in 2007
 1,093 persons in NC died due to suicide in 2007
 $530 million were spent in NC in 2007 for inpatient
hospitalizations
 According to the NC Institute of Medicine:
 Approximately 50,000 Disability-Adjusted Life Years were lost
in NC in 2005 due to unipolar depression
 In NC in 2006, per capita spending on mental health was
one of the lowest (43rd) in the nation, at $16.80. Of that
rate, the large majority goes to inpatient costs (65.5%
compared to a 37.1% national average)
Holmes, 2008; NC-CATCH Portal, n.d.; NC State Center for Health Statistics, 2009;
Thompson & Broskowski, 2006
Costs of Mental Illness
 In wake of mental health reform, researchers calculated:
 A 21.9% increase in number of adult hospital admissions for
Guilford Center LME, which went from 16,570 community
hospital adult admission days in SFY 2005-2006 to 18,939
admission days in SFY 2006-2007
 A 32.1% increase in number of child hospital admissions for
Guilford Center LME, which went from 2,005 community
hospital child admission days in SFY 2005-2006 to 2,849
admission days in SFY 2006-2007
 According to NCDMHDDSAS:
 For Q1 SFY 2009-2010, Guilford Center had 3rd highest LME ER
admission rate for mental health diagnoses (153.9 per 10,000)
 Guilford Center LME revenue and expenditures:
 Increase of $3,143,503, or 9.4%, from SFY 2006-2007 to SFY
2008-2009
Akland & Akland, 2008; Guilford Center, 2009; Budget and Finance Team, NCDMHDDSAS, n.d.;
Quality Management Team, NCDMHDDSAS, 2010
 Faith community-provider collaborations, like Congregational Nurse






Program
Emergency services at Guilford Center LME, Moses Cone Behavioral
Health Center; mobile crisis care from Therapeutic Alternatives
Peer-led support groups/family support from Mental Health
Associations in Greensboro and High Point, local NAMI chapter
Early-onset dementia support from Adult Center for Enrichment
Homeless support from Interactive Resource Center
Specialized mental health services from Tristan’s Quest, Youth Focus,
Youth Villages, Therapeutic Alternatives
Residential/independent life skills services from My Sister Susan’s
House, Destiny House, Sanctuary House, Joseph’s House, Shepherd
House
What were community perceptions on the following:
 Majority of survey respondents (73%) reported costs
associated with mental health services as a barrier to
accessing those services
 Only 14.6% say mental health services affordable in Guilford
 Fewest resources exist for:
 Children under age 12, immigrant populations, non-English
speaking populations, homeless persons
 Providers and consumers noted needs for:
 Coordination along continuum of care, step-down services,
peer support, child/adolescent psychiatrists, respite care,
intensive in-home services, specialized trauma services, home
health evaluations for the elderly
 Increasing understanding that mental illness and substance
abuse often co-occur; addressing these issues in tandem
 Barriers to Treatment (Community Feedback)
 Difficulty navigating system, cost, waiting lists,
transportation, mental health/physical
symptoms, childcare needs, service locations
 Examination of barriers and strategic planning to
minimize these may lead to increased service
utilization
Support Programs that Demonstrate Both Evidence-Based
Practice and Practice-Based Evidence
Foundation Action:
Prioritize programs that include:
1) Cognitive-Behavioral Frameworks
2) Motivational Interviewing (MI) Techniques
3) Consumer partnering
Support MI trainings within currently funded programs such as
Congregational Nurses and Social Workers programs.
Support supervision trainings on a subset of evidence-based practice
models
Potential Partners: Local provider networks, Guilford Center LME, NCDHHS
MH/DD/SAS, and local colleges and universities to provide training and
fidelity to evidence-based practice models.
Improve Access to Services
Foundation Action:
 Support strategic planning,
 Improvement of the available 1-800 access number
• Education and awareness of the number through marketing and
billboards throughout the community
• Training of staff regarding services available
 Consumer-friendly website
• Search for providers on the web using specific search criteria to fit
unique needs
• Housed in a neutral, community-based agency such as NAMI,
MHA in Greensboro or High Point, or Guilford CARES
• Content available in print (as well as in multiple languages) and
provided on a readable level to ensure health literacy
• Distributed as collaborative resource guides across the county in a
similar fashion to publications such as “Apartment Finders”
Potential Partners: Local provider networks, Guilford Center LME,
MHA, NAMI, Guilford CARES.
Increase Awareness of Co-Occurring Mental Health and
Substance Abuse as the Norm Rather than the Exception
Foundation Action:
 Develop a Community Action Strategic Plan (CASP)
 Support community dialogue
 Build capacity to deliver integrated mental health/substance abuse treatment
 Support Workforce Development Efforts
 Training (In-service and AHEC) related to co-occurring disorders (e.g.,
educational, assessment, and treatment)
 Special topics courses within local college and university graduate programs
 Expanding the focus to include discussions regarding co-occurring disorders
(modeled after local Say-It chapter)
• Monthly provider meetings on evidence-best practices around co-occurring
models and specific interventions.
• Monitoring of implementation to ensure quality
Potential Partners: Community-based mental health and substance abuse agencies, local
provider networks, Guilford Center LME, local and state consumer groups (NAMI, NCFU,
Guilford CARES), peer-to-peer support, AHEC, local colleges and universities.
Co-Locate Mental Health Services
Foundation Action:
 Support co-location of faith-based communities such as
Congregational Nurses and Congregational Social Workers Programs.
 Support programs that co-locate services in primary care settings
 Support provision of co-located services in school settings
 Mental health clinician in 2-3 schools.
 Foundation can support situations in which provider cannot
bill for services
 Support training for staff and teachers about mental health
signs and symptoms
Potential Partners: Local provider networks, Guilford Center LME,
Guilford County Schools, primary care clinics, pediatricians, local
colleges and universities.
Increase Attention to Special Populations
Foundation Action:
 Support programs targeting immigrant, homeless, and non-English speaking
populations
 Increase funding for interpreter training
 Interpreter Access Project
(http://cnnc.uncg.edu/programs/iap/iaptraining.htm).
 Raise awareness and advocate for Title VI compliance among providers
 Support continuing education opportunities in the interpreting profession
 Support translation of materials into next 2-3 most commonly occurring
languages
Potential Partners: Local provider networks, Guilford Center LME, communitybased organizations serving immigrant, homeless, and non-English speaking
populations, interpreter training programs such as Center for New North
Carolinians, AHEC, local colleges and universities.
Increase Attention to Service Gaps
Foundation Action:
 Fund programs that address service gaps
 availability of crisis beds, respite services, child/adolescent
psychiatry services, peer-to-peer services, specialized trauma
services (e.g., sexual assault support groups, returning military),
wraparound and step-down services, and services to assist in the
transition from adolescence to adulthood (i.e., emerging
adulthood services).
 Require funded programs to have a plan for addressing
transportation issues if the program is not community-based or inhome
Potential Partners: Local provider networks, Guilford Center LME,
community-based organizations, local and state consumer groups, local
colleges and universities.
Policy Implications
Foundation Action:
 Require funded direct service programs to have a supplemental or
sliding fee scale
 Fund programs implementing EBPs for a minimum of three years
 Favor EBP implementation programs that include regularly
tracked performance measures coupled with client incentives
 Support a demonstration project that:
1) addresses one of the identified service gaps AND;
2) utilizes blended or braided funding
Potential Partners: Local provider networks, Guilford Center LME,
community-based organizations, local colleges and universities,
local foundations (e.g., Weaver Foundation, Cemala Foundation,
Tannenbaum-Sternberger Foundation), Partners Ending
Homelessness work group
Conclusions
 Nationally identified public health priority
 Fundamental to physical health and quality of life
 Moving toward parity
 Local community priority
 People with mental problems are our neighbors. They
are members of our congregations, members of our
families; they are everywhere in this country. If we
ignore their cries for help, we will be continuing to
participate in the anguish from which those cries for
help come. A problem of this magnitude will not go
away. Because it will not go away…we are compelled to
take action.
~Rosalynn Carter
Questions
and
Comments
Contact Information
 Dr. Kelly Graves: [email protected]
 Anne Buford: [email protected]
 Dr. Sonja Frison: [email protected]
 Amanda Ireland: [email protected]
 Dr. Terri Shelton: [email protected]
330 S. Greene Street
Suite 200
Greensboro, NC 27401
336-217-9713