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Headlines: Why Mental Health Should Be Part of Health Reform. National Association of State Head Injury Administrators (NASHIA) Public Policy Symposium. March 26, 2009. Robert W. Glover, Ph.D. Executive Director National Association of State Mental Health Program Directors. Summary Slide. - PowerPoint PPT Presentation
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National Association of State Head National Association of State Head Injury Administrators (NASHIA) Injury Administrators (NASHIA)
Public Policy SymposiumPublic Policy Symposium
Robert W. Glover, Ph.D.Executive DirectorNational Association of State Mental Health Program Directors
March 26, 2009
Headlines: Why Mental Health Should Be Part of
Health Reform
Summary SlideSummary Slide
Who Are We?Who Are We? Who Do We Serve?Who Do We Serve? Where Do We Serve Them?Where Do We Serve Them? What is the Link Between Mental What is the Link Between Mental
Health and Health?Health and Health?– SmokingSmoking– ObesityObesity– Suicide PreventionSuicide Prevention– Returning VeteransReturning Veterans
NASMHPD
Represents the $29.5 Billion Public Mental Health System serving 6.1 million people annually in all 50 states, 4 territories, and the District of Columbia.
An affiliation with the approximately 220 State Psychiatric Hospitals: Serve 200,000 people per year and 50,000 people served at any point in time.
6.1 Million Persons Served by 6.1 Million Persons Served by SMHA Systems: 2006SMHA Systems: 2006
96% were served in the Community96% were served in the Community– 3.1% served in state psychiatric hospitals3.1% served in state psychiatric hospitals
22% were Employed22% were Employed– 48% were not in Labor Force48% were not in Labor Force
79% lived in Private Residences79% lived in Private Residences– 2.9% were homeless2.9% were homeless
71% reported positive outcomes from their services71% reported positive outcomes from their services 62% had some Medicaid coverage for their Mental 62% had some Medicaid coverage for their Mental
health serviceshealth services– 38% had No Medicaid Coverage38% had No Medicaid Coverage
2006 URS Reporting2006 URS Reporting
History of State History of State HospitalsHospitals
In 1954 there were:In 1954 there were:– 352 state hospitals352 state hospitals– 553,979 Residents in SH at the end of the year553,979 Residents in SH at the end of the year– 178,003 Admissions during the year178,003 Admissions during the year– 42,652 Deaths in state hospitals during the year 42,652 Deaths in state hospitals during the year
(Peaked in 1958 at 51,383 deaths)(Peaked in 1958 at 51,383 deaths)
In 2007In 2007::– 228 state hospitals (2007 NRI State Profiles)228 state hospitals (2007 NRI State Profiles)– 49,000 Residents (2007 NRI State Profiles)49,000 Residents (2007 NRI State Profiles)– 174,013 Admissions during the year (2006 URS)174,013 Admissions during the year (2006 URS)– Deaths: not reportedDeaths: not reported
Source: CMHS Uniform Reporting System, 2006
Number of Psychiatric Beds, By Number of Psychiatric Beds, By Type of Hospital and Year, U.S. Type of Hospital and Year, U.S. 1970 to 20021970 to 2002
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
1970 1976 1980 1985 1990 1995 1998 2000 2002
State Hospitals
Private PsychiatricHospitalsVA PsychiatricServicesGeneral Hospitals
Source: Mental Health United States, 2004
Psychiatric Beds as a Percent of Total Hospital Beds in the US, 1970 to 2002
33%
20%
14%
0%
5%
10%
15%
20%
25%
30%
35%
1970 1986 2002
In 1970, 1 out of 3 hospital
beds in America was a
psychiatric bed
In 2002, 1 out of 7 hospital beds in America was a psychiatric bed
Source: NIMH and NRI
State Mental Health Agency Controlled Expenditures for State Mental Health Agency Controlled Expenditures for State Psychiatric Hospital Inpatient and Community-State Psychiatric Hospital Inpatient and Community-Based Services as a Percent of Total Expenditures: FY'81 Based Services as a Percent of Total Expenditures: FY'81 to FY'05to FY'05
State Hospital Inpatient
27%
Community
70%
0%
10%
20%
30%
40%
50%
60%
70%
80%
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
USA TodayFront Page
Thursday,
May 3, 2007
People with Serious Mental People with Serious Mental Illness Experience 25 Years Illness Experience 25 Years Lost Life: A Public Health Lost Life: A Public Health CrisisCrisis
SmokingSmoking ObesityObesity SuicideSuicide
Substance AbuseSubstance Abuse Inadequate Inadequate
Medical CareMedical Care
People reporting a mental disorder in the past month consumed approximately 44.3% of all cigarettes smoked in the U.S.
Lasser, Karen; Boyd, J. Wesley; Woolhandler, Steffie; Himmelstein, David U.; McCormick, Danny; Bor, David H., "Smoking and mental illness: A population-based
prevalence study." JAMA, The Journal of the American Medical Association. Nov 22-29, 2000, 284, (20), 2606 - 2610.
A Free sample background from www.awesomebackgrounds.com
© 2002 By Default!Slide 14
Rates of smoking are Rates of smoking are 2-2-4 times4 times higher among higher among people people with with psychiatricpsychiatricdisorders disorders and and substance substance use use disorders.disorders.
Kalman D, Morissette SB, George TP. American Journal on Addictions. 2005, 106-123.Kalman D, Morissette SB, George TP. American Journal on Addictions. 2005, 106-123.
Major depression 50 to 60 % Anxiety disorder 45
to 60 % Bipolar disorder 55
to 70 % Schizophrenia 65
to 85 %
Presentation at the NASMHPD Medical Directors Council Technical Report Meeting on Smoking Policy and Treatment at State Operated Psychiatric Hospitals, April
20-21, 2006, San Francisco, California. * DeLeon et al., in press.
Smoking Prevalence among Smoking Prevalence among People with Mental Illnesses:People with Mental Illnesses:
* 20% of those with schizophrenia started smoking at college age and many began smoking in mental health settings receiving cigarettes for good behavior.
Rates of smoking among treatment staff in mental health and substance abuse facilities and programs are higher than other health care professionals:
NASMHPD Research Institute, Inc. (2006). Survey on Smoking Policies and Practices for Psychiatric Facilities.*** Strouse R, Hall J and Kovac M. Survey of Health Professionals' Knowledge, Attitudes, Beliefs, and Behaviors
Regarding Smoking Cessation Assistance and Counseling. Princeton, N.J.: Mathematica Policy Research, Inc., 2004, 1-16.
30%-35% of Mental 30%-35% of Mental Health Providers SmokeHealth Providers Smoke
Primary Care Physicians 1.7 %
Emergency Physicians 5.7 %
Psychiatrists 3.2 % Registered Nurses 13.1
%Dentists
5.8 %Dental Hygienists 5.4 %Pharmacists 4.5 %
***
Obesity, Metabolic Obesity, Metabolic Syndrome, and Syndrome, and
Diabetes EpidemicDiabetes Epidemic
No Data Less than 4% 4% to 6% Above 6%
Mokdad et al. Diabetes Care. 2000;23:1278-1283.
Diabetes and Gestational Diabetes Trends: Diabetes and Gestational Diabetes Trends: US Adults, BRFSS 1990US Adults, BRFSS 1990
Mokdad et al. JAMA. 2001;286(10).
Diabetes and Gestational Diabetes Diabetes and Gestational Diabetes Trends: Trends:
US Adults, BRFSS 2000US Adults, BRFSS 2000
No Data Less than 4% 4% to 6% Above 6%
www.diabetes.org.
No Data Less than 4% 4% to 6% Above 6% Above 10%
Diabetes and Gestational Diabetes Diabetes and Gestational Diabetes Trends: Trends:
US Adults, Estimate for 2010US Adults, Estimate for 2010
Suicide PreventionSuicide Prevention Suicide is the leading cause of violent Suicide is the leading cause of violent
deaths worldwidedeaths worldwide In the United StatesIn the United States
– Number of deaths by suicide in 2004: Number of deaths by suicide in 2004: 32,43932,439 (CDC WISQARS website and “Fatal Injury Reports”: (CDC WISQARS website and “Fatal Injury Reports”: http://www.cdc.gov/ncipc/wisqars)http://www.cdc.gov/ncipc/wisqars)
– Deaths per 100,000 population: Deaths per 100,000 population: 11.111.1– An average of 1 person every 16.2 An average of 1 person every 16.2
minutes died by suicide.minutes died by suicide.– Many of them preventable through timely Many of them preventable through timely
intervention.intervention. National Suicide Prevention Lifeline: National Suicide Prevention Lifeline:
1-800-273-TALK1-800-273-TALK
*Press 1 for Veterans Services
Mental Illnesses are Chronic Mental Illnesses are Chronic Illnesses that Impose Great Costs on Illnesses that Impose Great Costs on
Our SocietyOur Society In 2002, mental illnesses contributed to In 2002, mental illnesses contributed to $193 billion$193 billion
in lost productivity in lost productivity • More than the revenue of 499 of the Fortune 500 companiesMore than the revenue of 499 of the Fortune 500 companies• By 2013, this figure is estimated to rise to more than By 2013, this figure is estimated to rise to more than $300 $300
billionbillion. .
The World Health Organization has found that The World Health Organization has found that depression was the depression was the fourthfourth leading cause of disease- leading cause of disease-burden in 1990 and by 2020 will be the burden in 1990 and by 2020 will be the singlesingle leading cause. leading cause.
Indeed, mental illness is already the Indeed, mental illness is already the leadingleading cause cause of disability for people between 15 and 44 in the of disability for people between 15 and 44 in the United States and Canada. United States and Canada.
Mental Illnesses are Chronic Illnesses that Impose Great Costs
on Our Society (Cont)
Data from the Agency for Healthcare Data from the Agency for Healthcare Research and Quality (AHRQ) shows that Research and Quality (AHRQ) shows that expenditures for adults with a specific expenditures for adults with a specific chronic condition AND a mental health chronic condition AND a mental health condition greatly exceed expenditures for condition greatly exceed expenditures for those without a mental health conditionthose without a mental health condition
Annual Medical Expenditures for Adults with a Specific Chronic Condition, with and without a Mental Health
Condition
Cost without mental health condition
Cost with mental health condition
All adults * $1,913 $3,545
Heart condition
4,697 6,919
High blood pressure
3,481 5,492
Asthma 2,908 4,028
Diabetes 4,172 5,559*-Refers to all adults with and without chronic conditions.
Information from U.S. Department of Health and Human Services. The 2002 and 2003 MEPS. AHRQ, Rockville, Md.
People with Serious Mental People with Serious Mental Illness Experience 25 Years Illness Experience 25 Years Lost LifeLost Life
People with schizophrenia die People with schizophrenia die from diabetes at from diabetes at 2.7 2.7 times the times the rate of the general populationrate of the general population– 2.3 2.3 times the rate from times the rate from
cardiovascular diseasecardiovascular disease– 3.23.2 times the rate from respiratory times the rate from respiratory
diseasedisease– 3.43.4 times the rate from infectious times the rate from infectious
diseases. diseases.
Depression and Other Depression and Other ConditionsConditions The likelihood of heart attack is The likelihood of heart attack is
fourfour times greater for persons times greater for persons with depression than in general with depression than in general population; the likelihood of population; the likelihood of stroke is stroke is 2.62.6 times greater. times greater.
Inadequate Healthcare Inadequate Healthcare and Insuranceand Insurance
Many people with mental health suffer Many people with mental health suffer from chronic conditions simply because from chronic conditions simply because they are not receiving appropriate they are not receiving appropriate healthcare. healthcare.
People with mental illnesses are People with mental illnesses are uninsured at twice the rate of the uninsured at twice the rate of the general population: general population: 34%34% of people with of people with mental illness have no health coverage mental illness have no health coverage at this point. at this point.
In other words, many people with In other words, many people with mental illnesses are excluded from our mental illnesses are excluded from our nation’s porous healthcare system right nation’s porous healthcare system right from the start. from the start.
Mental Health Is Essential to Health:Mental Health Is Essential to Health:
Need for Prevention ApproachNeed for Prevention Approach We must also approach prevention We must also approach prevention
across the lifespan and work to provide across the lifespan and work to provide the appropriate screens, starting with the appropriate screens, starting with well-child visits that can identify the co-well-child visits that can identify the co-occurrence of mental health and chronic occurrence of mental health and chronic conditions. conditions.
It has long been a popular belief that It has long been a popular belief that mental illnesses begin in late mental illnesses begin in late adolescence or early adulthood. In fact, adolescence or early adulthood. In fact, this is a misconception. this is a misconception. The average The average age of onset for mental disorders is 14. age of onset for mental disorders is 14.
Role of TraumaRole of Trauma
We must develop a better understanding We must develop a better understanding of role trauma plays in mental health of role trauma plays in mental health conditions and then employ approaches conditions and then employ approaches that mitigate trauma’s effect. that mitigate trauma’s effect.
We must understand and address We must understand and address maternal depression, the consequences maternal depression, the consequences it can have on a young child’s physical it can have on a young child’s physical and emotional development, and the and emotional development, and the ways it can play out over the span of that ways it can play out over the span of that young child’s life. young child’s life.
Returning VeteransReturning Veterans
Center for the Study of Traumatic Stress
I would be seen as weak
My unit leadershipmight treat me differently
Members of my unit might haveless confidence in me
It would harm my career
My leaders would blame mefor the problem
*Participants were asked to “rate each of the possible concerns that might affect your decision to receive mental health counseling or services if you ever had a problem.”Hoge CW, et al. N Engl J Med. 2004;351:13-22.
Barriers to Care and Mental Health Risk*
24
20
31
33
31
50
51
59
63
65
0 10 20 30 40 50 60 70 80
Agree or Strongly Agree, %
Screen posScreen neg
Provided byRobert Ursano, M.D.
Center for the Study of Traumatic Stress
I don’t have adequate transportation
I don’t trustmental health professionals
I don’t know whereto get help
There would be difficulty getting time off work for treatment
It is difficult toschedule an appointment
Barriers to Care and Mental Health Risk*
(cont’d)
*Participants were asked to “rate each of the possible concerns that might affect your decision to receive mental health counseling or services if you ever had a problem.”Hoge CW, et al. N Engl J Med. 2004;351:13-22.
6
6
17
22
38
18
22
45
55
17
0 10 20 30 40 50 60 70 80
Screen posScreen neg
Agree or Strongly Agree, %Provided byRobert Ursano, M.D.
Center for the Study of Traumatic Stress
How many Americans have returned from Iraq or Afghanistan?
1.6 Million ** Figure does not count contractors
If it were evenly distributed that would be 30,000 per state.
If all were combat exposed that might be 6000 cases of PTSD/Depression per state.
If ¼ combat then 1500 cases PTSD and TBI (1/6 combat exposed with TBI) 1250 cases TBI per state.
Provided byRobert Ursano, M.D.
NASMHPD President’s Task Force on NASMHPD President’s Task Force on Returning VeteransReturning Veterans
Charge:Charge: To address issues related to the provision To address issues related to the provision of mental health services provided to veterans of mental health services provided to veterans (and their families) returning home from Iraq and (and their families) returning home from Iraq and Afghanistan.Afghanistan.
Survey of States’ ServicesSurvey of States’ Services
MembersMembersCommissionersCommissioners Nancy Rollins (New Hampshire)…ChairNancy Rollins (New Hampshire)…Chair Linda Roebuck (New Mexico)Linda Roebuck (New Mexico) Mike Lancaster (North Carolina)Mike Lancaster (North Carolina) Terri White (Oklahoma)Terri White (Oklahoma)Medical DirectorsMedical Directors Alan Radke (Minnesota)Alan Radke (Minnesota) Jim Evans (Virginia)Jim Evans (Virginia)Division RepresentDivision Representativeative Joan Smyrski (Maine)Joan Smyrski (Maine)
Returning Veterans Returning Veterans NASMHPD InitiativesNASMHPD Initiatives
Addressing Issue at NASMHPD Addressing Issue at NASMHPD Commissioner Meetings (Winter Commissioner Meetings (Winter 2007, Winter 2008, Summer 2007, Winter 2008, Summer 2009)2009)
Veterans Administration on Veterans Administration on Suicide Prevention and Potential Suicide Prevention and Potential PartneringPartnering
SAMHSA Grant Announcement on SAMHSA Grant Announcement on Jail Diversion and Trauma – Jail Diversion and Trauma – Priority VeteransPriority Veterans
Thank You!Thank You!