The Strategy for Intervention B4Stage4Paul Gionfriddo, President and CEO
Mental Health America
MHAScreening.org
Presentation Outline
• Why Screen?
• Overview of the (Ongoing) Results.
• Examining Subpopulations.
• Breakdowns by Demographic Group
• Breakdowns by Co-Occurring Condition
• Local Data.
• Call to Action.
Screening Promotes Integration.
Why Screen?
More Screening = Better Healthcare
• Screening in primary care perceived as helpful 93% of the time;
• PCPs 3 times more likely to recognize MI symptoms and follow up;
• Post-screening treatment changes were made 40% of the time;
• Positive benefits persist one year later.
Sources: Christensen, et al, 2005; Pignone et al, 2002; O’Connor et al, 2009; Duffy et al, 2009.
Screening Promotes Recovery
People who screen regularly are:
• More attuned to their symptoms;
• More knowledgeable about their conditions;
• Better able to communicate with their provider;
• Able to recognize improvement early in
treatment;
• More aware of the warning signs of relapse;
• Better able to self-manage their illness.
Prevention
Early Identification
and Intervention
Integrated Care and
Treatment
Recovery
MHA’s B4Stage4 Prevention/Recovery Model:Where Screening Fits
Intervention B4Stage 4: Why Screen?
MHA Online Screening ToolsDepression (PHQ-9)
Anxiety (GAD-7)
Bipolar
PTSD (PC-PTSD)
Youth Screen (PSC-YR)
Parent Screen (PSC)
Alcohol and Substance Use Screen (CAGE-AID)
Psychosis Screen (Ultra-High Risk) (PQ-B)
Work Health Survey
MHA Screening Links Early ID to Treatment and Recovery.
Overview of the Ongoing Results.
Overall Screening Numbers: Fast Facts
Screening Web site: www.mhascreening.org
• Number of Screening Tools Available: 9
• % of Screens Started That are Completed: 90%
Number of Screens completed: 650,000+
• % Female: 74%
• % Under Age 25: 54%
Current Monthly Average: 85,000
• % Positive or Moderate-to-Severe (all conditions): 66%
• % Never Been Diagnosed (of everyone taking a screen): 67%
10
Screenings Completed, by Screen, Yr 1
11
AnxietyScreening
BipolarScreening
DepressionScreening
PTSDScreening
17.4% 18.0%
58.9%
5.7%
Screening Summary Breakdown
Source: www.mhascreening.org
White69%
Non-White
Positive66%
Negative
Female75%
Male
Been DiagnosedNever
Been Diagnosed
65%
Screeners, by Age
13
50%
22%
12%
9%
5% 2%
37%
28%
18%
8%
5%3%1%
"11-17"
"18-24"
"25-34"
"35-44"
"45-54"
"55-64"
"65+"
Inner Circle Apr 14-Apr 15
n= 242,204
Outer CircleMay-Jul 15n= 116,054
Screeners, by Race/Ethnicity
14
6.0%
7.2%
10.2%
4.2%
0.9%2.2%
69.2%
Asian or Pacific Islander
Black or AfricanAmerican (non-Hispanic)
Hispanic or Latino
More than one of theabove
Native American orAmerican Indian
Other
White (non-Hispanic)
White, Non-Hispanic
N=242,204
Screeners’ Income Distribution
15
0%
5%
10%
15%
20%
25%
30%
35%
Percent Positive* for Each Condition
16* “Moderate” to “Severe” = “Positive”
Moderate Anxiety
7%
Severe Anxiety
10%
Moderate Depression
19%
Moderately Severe
Depression24%
Severe Depression
25%
Positive Bipolar
9%
Positive PTSD6%
N=173,418
Almost All of Those Taking Psychosis Screening Are At Risk
95%
5%
Psychosis Risk
No/Low Risk
17
N=2517, May-August, 2015
Three-Fourths Likely for Substance Use Disorder
77%
23%
Likely
Unlikely
18N=2971, May-August, 2015
What Will Screeners Do for Follow-up?
19
0% 10% 20% 30% 40%
Discuss with a family or friend
Discuss with MH professional
Discuss with primary care doc
Take screens regularly
Do nothing
Take a screen immediately
Support After Screening: What Screeners Want
20
Online, self-help
apps/tools27%
A way to contact a
peer15%
More info about where to go for help
32%
Find providers in
my area17%
Other9%
N= 242,204
Word Cloud: What Do They Want?
21
Different Demographic Groups Yield Both Similar and Differing Results
Examining Subpopulations 1
Multi-Racial Individuals Most Positive or Moderate to Severe
23
72% 69%74%
80% 77% 75% 74%
60%72%
N=242,204
Are People Who Self-ID as LGBT More Likely to Experience MH Concerns?
20.3%
2.3%
LGBT Screeners
LGBT General Population
24N=79552, May – August 2015
Source: CDC, 2013
Children and Mental Illness: Early Warning Signs
25
Anxiety Screening
6%
Bipolar Screening
16%
Depression Screening
70%
PTSD Screening
1%
Youth Screening
7%
N=36,346 (May-July 2015). PTSD, SUD, and Parent Screens were <1% combined.
80.4% of youth taking youth screen were positive/at risk. Results of other screens not validated for youth.
Children and Mental Illness: Even Earlier Warning Signs
62%
38%
Parent Screening Results
At Risk
Not at Risk
26
N=1616, May-August, 2015
Young (<25) Women Slightly More Likely to have Positive Result
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Positive Negative
Young Women Young Men
27
N=99654, May-August, 2015
Caregivers are Most Frequently Positive for PTSD and Depression
28
78.4%71.3%
48.2%
81.4% 81.9%
Alcohol orSubstance Use
Screening
Anxiety Bipolar Depression PTSD
N=6,303 (2015). 30% (versus 65% of overall screeners) were under 25; 14% (versus 1% of overall screeners) were 55+.
Vets/Active Duty: More Worried About Depression, Bipolar, Anxiety than PTSD
29
0 500 1000 1500 2000
Depression
Bipolar
Anxiety
PTSD
Other
N=2855
Source: MHA Screening, May 2015-July 2015
79% Positive
49% Positive
68% Positive
79% Positive
Who Has PTSD?
30
0
200
400
600
800
1000
1200
New Moms Vets Caregivers Students
83%+
85%+
79%+
82%+
N=73,735. Note: Screeners could choose more than one category.
Race/Ethnicity: Blacks Most Likely to Do Something
31
45%
30%35%
39%35%
43%
35% 35% 36%
Percent Saying “Will Do Nothing” with Results
Screening Results: Men More Likely to do Nothing
32
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Discussresults with
family orfriend
Discussresults with
MHprofessional
Discussresults with
PCP
Take regularscreens
Do nothing Takeanotherscreen
immediately
Female
Male
Mental Illnesses Frequently Co-Occur with Other Conditions
Examining Subpopulations 2
Research Backdrop on Co-Occurring Conditions
• People with diabetes: 2x more likely to have depression.
• Adults with depression: 2x more likely to develop cardiovascular disease.
• 25% of cancer patients also have major depressive disorder.
• 50% of people with chronic pain also have depression.
• 50% with depression also have anxiety disorder.
Sources: NIH, VA, ADAA
34
14 Percent Have Other Chronic Conditions
35
Pain31%
Lung13%Diabetes
13%
Heart8%
ADD/HD3%
Cancer3%
Migraines1%
Other28%
Source: MHA Screening, May-August, 2015
No Co-Occurring
86%
Co-Occurring
14%
People Reporting Chronic Pain Who are Positive for a Mental Illness
77%
23%
Positive
Negative
36
N=10353, May-August 2015
People Reporting COPD/Lung Disease Who are Positive for a Mental Illness
80%
20%
Positive
Negative
37
N=4150, May-August, 2015
People Reporting Alzheimer’s Who are Positive for a Mental Illness
75%
25%
Positive
Negative
38
N=235, May-August, 2015
People Reporting Diabetes Who Are Positive for a Mental Illness
74%
26%
Positive
Negative
39
N=4162, May-August, 2015
People Reporting Cancer History Who are Positive for a Mental Illness
71%
29%
Positive
Negative
40
N=935, May-August, 2015
Note: 63% positive for depression v. 25% with MDD in earlier research data.
How Does Our Community Look?
Local Results
Palm Beach County By the Numbers
• Total Number of Screeners (through August 2015): 648
• Percent Female: 68% (versus 75% Florida and National)
• Most Common Screen: Depression (58% - Same as National)
• Roughly one in four PBC Screeners reports having at least one other chronic condition.
• 36% identify as students; 13% as LGBT; and 4% as caregivers.
42
PBC Screening Reaches a More Diverse Population
43
0% 20% 40% 60% 80%
Asian or Pacific Islander
Black or African American(non-Hispanic)
Hispanic or Latino
More than one of the above
Native American or AmericanIndian
Other
White (non-Hispanic)
PBC
Florida
National
PBC Screeners are Older
44
0%
5%
10%
15%
20%
25%
30%
35%
40%
"11-17" "18-24" "25-34" "35-44" "45-54" "55-64" "65+"
National Florida PBC
N=116054 (National), May – August, 2015
Similar in Income, Slightly Wealthier
45
0%
5%
10%
15%
20%
25%
30%
35%
National
Florida
PBC
Percent Positive, by Contribution to Total by Condition
46
0%
10%
20%
30%
40%
50%
60%
70%
80%
National Florida PBC
Positive PTSD
Positive Bipolar
Severe Depression
Moderately SevereDepression
Moderate Depression
Severe Anxiety
Moderate Anxiety
72% 73% 72%
Ever Been Diagnosed?
47
66.89% 67.49% 66.37%
33.11% 32.51% 33.63%
National Florida PBC
No Yes
People in PBC Most Likely to Report Having Co-Occurring Conditions
14%
22%
28%
National Florida Palm Beach
48
What We Can Do with the Results to Inform Policy and Practice.
Call To Action
What Young People (11-17) Say They Want
50
10% 9%
38%
46%
57%
Phone Number Referral toAffiliates
Worksheets Online MobileApps - trackand managesymptoms
AdditionalInformation
about mentalhealth
N=17969, May-July 2015
What Caregivers Say They Want
51
19%26%
54%49%
41%
Phone Number Referral toAffiliates
Worksheets Online MobileApps - track and
managesymptoms
AdditionalInformation
about mentalhealth
N=4085, May-July, 2015
What Active Duty/Veterans Say They Want
52
19%22%
48%42% 42%
Phone Number Referral toAffiliates
Worksheets Online MobileApps - track and
managesymptoms
AdditionalInformation
about mentalhealth
N=1491, May-July, 2015
Different Demo Groups Want Different Things, But Everyone Wants Online Help and Info
53
0%
5%
10%
15%
20%
25%
30%
35%
40%
Online, Self HelpApps
Contact a Peer
Info about whereto get MH help
Help FindProviders
Other (pleasespecify)
PBC Residents Want More Help Finding Treatment
54
0%
5%
10%
15%
20%
25%
30%
35%
Discussresults with
family,friend or
pro
Findadditional
informationonline
Findtreatment
Monitor myhealth
Do Nothing
National
Florida
PBC
Screeners in PBC Want a More Personal Touch – Helpline and Affiliate Connection
55
0%
10%
20%
30%
40%
50%
60%
Phone # forimmediateassistance
Referral toAffiliate
Worksheetsor Coping
Skills to useat home
OnlineMobile Apps- track and
managesymptoms
More Infoabout MH
National
Florida
PBC
MHA’s Advocacy for Screening
Mental health screening should be as commonplace as vision, hearing, dental, and blood pressure screening.
It should be conducted in clinicians’ offices, communities, schools, and workplaces.
Revision of the Free Care Rule (December 2014) makes free screening in schools reimbursable by Medicaid.
56
MHA’s Screening to Treatment and Recovery
Online Screening
S2T Apps and Interactive Web
Environment
Paid MHA apps.
Vendor Opportunities
Clinical Tools and Worksheets
Improved, Linked Web Content
Referrals to Affiliates
Helplines; Local and Peer Support
57
Using Screening Results for Education and Evaluation
Online Screening
Special URLs for
Population Tracking
Regular and
Special Reports
Informing Policy and Practice
58
Thank You!