Letters from the CEO: November 2006
Dear National Council Member:
Re: The National Tragedy of Premature Deaths
My monthly email letters update you on pressing issues and National Council activities. However a letter covering many topics cannot convey the extent of our efforts to examine, understand and address an issue from a public policy as well as an operations/practice perspective. Given the array of policy updates, newsletters, and conference calls we now make available to members, it feels right to use this letter to offer a more thorough analysis of a specific issue. So this month and for the next few months, I will concentrate each letter in one critical area. And I can think of no more critical issue facing us today, than new data revealing the premature deaths of persons with serious mental illness.
As a specialty of healthcare, behavioral health has an obligation to foster not just healthy minds, but healthy lives. After all, our struggle to help people with mental illnesses and addictions recover would be futile if their very lives were endangered due to unattended chronic medical conditions. A national tragedy that reflects this very situation is assuming alarming proportions. While we've known for years that persons with serious mental illness die younger than the general population, a recent federal study has revealed that the rate of morbidity and mortality has accelerated - persons with serious mental illness are now at risk of dying 25 years younger than the general population.
These tragic findings were most recently featured in Morbidity and Mortality in People with Serious Mental Illness, a technical report just released by the National Association of State Mental Health Program Directors. The report looks at state studies comparing the mortality of consumers of public mental health services with the mortality of the states' general population using age-adjusted death rates, standardized mortality ratios, and years of potential life lost. The results corroborate what we have been hearing anecdotally from many of you. And reiterate the need for better connection between general health and behavioral health emphasized by former Surgeon General Satcher, Bazelon, the President's New Freedom Commission on Mental Health, and the Institute of Medicine. The findings are a national call to action.
The NASMHPD report, available at www.nasmhpd.org, reviews the causes of the increased morbidity and mortality - cardiovascular disease, diabetes, respiratory disease, and infectious diseases, including HIV/AIDS; and recommends strategic approaches to reducing illness and premature death among this population. Their recommendations are focused on community services directly run by state mental health authorities.
Despite enormous constraints, and with little support from government, there are National Council members that have cobbled together innovative clinical and financing models in order to provide comprehensive care. Collaboration has taken many forms: co-located mental health and primary care services; contracting; enhanced referral processes; sharing of patient information; and cross-training of mental health and primary care staff. And the National Council has tried to support these pioneers. We've offered: conceptual models; "how to" manuals; and workshops and institutes at our Annual Conference. But we have been less successful in encouraging a national dialogue about the resources that not-for-profit and proprietary behavioral healthcare agencies need to ensure that people with serious mental illness and addiction disorders are adequately screened and triaged for physical illnesses.
Most of the national attention and activity to date has focused on primary care sites. Acknowledging that mental health is integral to overall health, the Health Resources Services Administration has underwritten mental health expansion initiatives in community health centers. As a result, the percentage of community health centers providing mental health services has grown from 53.8% in 1999 to 72.2% in 2004, representing 139.8% growth in the number of persons served and 75.9% growth in mental health visits.
Sadly, general healthcare for people with serious psychiatric illnesses and addiction disorders being served in community based behavioral health organizations has had far less attention, and no additional funding support. And funding is needed to right this wrong. Funding will enable organizations to pay skilled staff, to allocate adequate space and to buy basic equipment. Screening and evaluation for behavioral health disorders is appropriate in primary care settings, and screening and evaluation for general health problems should be available to individuals in behavioral health settings.
What is the National Council doing to help?
Best Regards,
Linda
Re: The National Tragedy of Premature Deaths
My monthly email letters update you on pressing issues and National Council activities. However a letter covering many topics cannot convey the extent of our efforts to examine, understand and address an issue from a public policy as well as an operations/practice perspective. Given the array of policy updates, newsletters, and conference calls we now make available to members, it feels right to use this letter to offer a more thorough analysis of a specific issue. So this month and for the next few months, I will concentrate each letter in one critical area. And I can think of no more critical issue facing us today, than new data revealing the premature deaths of persons with serious mental illness.
As a specialty of healthcare, behavioral health has an obligation to foster not just healthy minds, but healthy lives. After all, our struggle to help people with mental illnesses and addictions recover would be futile if their very lives were endangered due to unattended chronic medical conditions. A national tragedy that reflects this very situation is assuming alarming proportions. While we've known for years that persons with serious mental illness die younger than the general population, a recent federal study has revealed that the rate of morbidity and mortality has accelerated - persons with serious mental illness are now at risk of dying 25 years younger than the general population.
These tragic findings were most recently featured in Morbidity and Mortality in People with Serious Mental Illness, a technical report just released by the National Association of State Mental Health Program Directors. The report looks at state studies comparing the mortality of consumers of public mental health services with the mortality of the states' general population using age-adjusted death rates, standardized mortality ratios, and years of potential life lost. The results corroborate what we have been hearing anecdotally from many of you. And reiterate the need for better connection between general health and behavioral health emphasized by former Surgeon General Satcher, Bazelon, the President's New Freedom Commission on Mental Health, and the Institute of Medicine. The findings are a national call to action.
The NASMHPD report, available at www.nasmhpd.org, reviews the causes of the increased morbidity and mortality - cardiovascular disease, diabetes, respiratory disease, and infectious diseases, including HIV/AIDS; and recommends strategic approaches to reducing illness and premature death among this population. Their recommendations are focused on community services directly run by state mental health authorities.
Despite enormous constraints, and with little support from government, there are National Council members that have cobbled together innovative clinical and financing models in order to provide comprehensive care. Collaboration has taken many forms: co-located mental health and primary care services; contracting; enhanced referral processes; sharing of patient information; and cross-training of mental health and primary care staff. And the National Council has tried to support these pioneers. We've offered: conceptual models; "how to" manuals; and workshops and institutes at our Annual Conference. But we have been less successful in encouraging a national dialogue about the resources that not-for-profit and proprietary behavioral healthcare agencies need to ensure that people with serious mental illness and addiction disorders are adequately screened and triaged for physical illnesses.
Most of the national attention and activity to date has focused on primary care sites. Acknowledging that mental health is integral to overall health, the Health Resources Services Administration has underwritten mental health expansion initiatives in community health centers. As a result, the percentage of community health centers providing mental health services has grown from 53.8% in 1999 to 72.2% in 2004, representing 139.8% growth in the number of persons served and 75.9% growth in mental health visits.
Sadly, general healthcare for people with serious psychiatric illnesses and addiction disorders being served in community based behavioral health organizations has had far less attention, and no additional funding support. And funding is needed to right this wrong. Funding will enable organizations to pay skilled staff, to allocate adequate space and to buy basic equipment. Screening and evaluation for behavioral health disorders is appropriate in primary care settings, and screening and evaluation for general health problems should be available to individuals in behavioral health settings.
What is the National Council doing to help?
- The National Council is aggressively pursuing a legislative agenda to create a new federal grant program to co-locate primary care services within behavioral healthcare organizations.
- The National Council is conducting a Behavioral Health/Primary Care Coordination survey to fully catalogue member efforts and assess opportunities and barriers to collaboration. The survey is available at www.nccbh.org. Please respond by December 15, the data you provide is vital to our legislative efforts.
- The National Council is telling your story. Our response to the NASMHPD report on your behalf and the work of our providers received extensive coverage in the latest issue of Mental Health Weekly (see pages 1, 5, and 6). Watch your email and our website for a copy of our press release on this issue to other trade and national media. A recent issue of our own National Council News features provider challenges and success stories in implementing coordinated care models. You can find the issue here.
- A National Council pilot project is underway to increase primary care clinics' ability to screen for mental health disorders and to effectively connect with community mental health organizations.
- A National Council educational initiative currently in design will help mental health and addictions treatment administrators and practitioners understand the prevalence of physical illnesses among the individuals they treat, assess risk factors, provide patient education and lifestyle management, and facilitate collaboration with physical medicine.
Best Regards,
Linda
