Plenary III:There is No Health

Without Mental Health

Disclosures• Alexandra Quittner– Investigator-initiated grants: Novartis & Insmed– Consultant to Vertex, AbbVie, and Novartis– Research support from CF Foundation, EU, Australia NHMRC

• Stuart Elborn– Clinical trials and consultancy with Novartis, Vertex,

Celtaxsys, Corbus– Research support from MRC, EC Framework 7, CF Trust UK– European CF Society

• Beth Smith– Grant support from the Cystic Fibrosis Foundation and the

New York State Office of Mental Health

There Is No Health Without Mental Health

Beth A. Smith, MDUniversity of Buffalo

School of Medicine and Biomedical SciencesBuffalo NY USA

Mental Health Screening RecommendationsIndicated

Patient Population Organization

Children, 11-21 yrs American Academy of Pediatrics1

Adolescents & Adults US Preventative Services Task Force2, 3

Adults UK NICE Mental Health Guidelines 4

Cancer American Society of Clinical Oncology5

Coronary Heart Disease American Heart Association6

Diabetes American Diabetes Association7

3-Ann of Internal Med. 2009;151(11):784-7922-Pediatr. 2009;123(4):1223-1228

5-Oncology. 2014;32(15):1605-16196- Circulation. 2008;118(17):1768-17757- Diabetes care. 2008;31 Suppl 1:S12-54.

1-Pediatr. 2014;133(3):568-5704- BPS. 2010

From Consensus to Action

• We have a great opportunity to improve the health and quality of life of our patients and families– But there is a lot of work to do!

• Currently, our capacity to provide comprehensive mental health care is modest

How Are We Going To Do This?

Implementation Support

Recommendations Educational Materials

Guidance on What to Do and How to Do itThe International Committee on Mental Health in CF

Implementation

The CF Foundation Mental Health Task Force• A committee established by the CF Foundation – Responsible for supporting implementation of the

International Mental Health Guidelines– Our goal: accessible toolkits for implementation

• Produced CF Mental Health White Paper:"Recommendations for CFF Support of Prevention,

Screening and Treatment of Anxiety and Depression in Individuals with Cystic Fibrosis and Their Parent Caregivers”

– Current scientific evidence – Expert consensus– Comprehensive analysis of centers currently

screening

Manual of Procedures and Toolkit for Guideline Implementation

• Created at Buffalo, used by Lurie Children's Hospital in Chicago to implement their screening

• This tool assists the CF center in putting the mental health guidelines into practice – User friendly and applicable tool for real world CF

center practices – Provides step by step information,

recommendations, educational resources, and tools

– Tools are broadly relevant, easy to use, and free

Educational Materials for Staff

Pamphlets for Patients/Families

Additional Resources• Psychotherapy– Manual: How to Create Referral Networks– Handouts on psychotherapy for patients/parents– Handout on CF for mental health care providers– Training: CBT Short Course

• Psychopharmacology– Tabulation of 1st line medications recommended to

treat depression and/or anxiety 1

• Dosing, titration schedule, target doses• Adjustments for renal and hepatic impairments • Drug-Drug interactions

– Training: Psychopharmacology Short Course

1 Quittner et al. Thorax. October 2015; epub

Integrating Behavioral Health into the CF Clinic: The Collaborative Care Model

• Establish a position of mental health coordinator – (clinical social worker, psychologist, etc.)

• Task with developing and implementing strategies for:– Prevention– Screening – Case management for those needing interventions

• Provide direct care if trained in psychotherapy

CF Foundation RFA for Mental Health Support

• Designed to facilitate implementation of the Guideline recommendations

• Seed funding for a CF Foundation Mental Health Coordinator

• Designated for hiring additional staff or increase in FTE of existing staff who will focus on mental health coordination or psychosocial intervention

Summary

• Mental health is an unmet clinical need which can positively affect CF disease management

• Mental Health Guidelines are a step to assist the CF community in the assessment and treatment of anxiety and depression– Patients and families recognize this need and are

receptive to screening• We have worked hard to remove implementation

barriers– < 10 minutes to perform the screening– CF Foundation Mental Health RFA provides a vehicle

to support these activities in CF Centers

There Is No Health Without Mental Health