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National Association of State Head Injury Administrators (NASHIA) Public Policy Symposium

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.

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National Association of State Head Injury Administrators (NASHIA) Public Policy Symposium

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  1. 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

  2. Summary Slide • Who Are We? • Who Do We Serve? • Where Do We Serve Them? • What is the Link Between Mental Health and Health? • Smoking • Obesity • Suicide Prevention • Returning Veterans

  3. 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.

  4. 6.1 Million Persons Served by SMHA Systems: 2006 • 96% were served in the Community • 3.1% served in state psychiatric hospitals • 22% were Employed • 48% were not in Labor Force • 79% lived in Private Residences • 2.9% were homeless • 71% reported positive outcomes from their services • 62% had some Medicaid coverage for their Mental health services • 38% had No Medicaid Coverage 2006 URS Reporting

  5. History of State Hospitals • In 1954 there were: • 352 state hospitals • 553,979 Residents in SH at the end of the year • 178,003 Admissions during the year • 42,652 Deaths in state hospitals during the year (Peaked in 1958 at 51,383 deaths) • In 2007: • 228 state hospitals (2007 NRI State Profiles) • 49,000 Residents (2007 NRI State Profiles) • 174,013 Admissions during the year (2006 URS) • Deaths: not reported Source: CMHS Uniform Reporting System, 2006

  6. Number of Psychiatric Beds, By Type of Hospital and Year, U.S. 1970 to 2002 Source: Mental Health United States, 2004

  7. Psychiatric Beds as a Percent of Total Hospital Beds in the US, 1970 to 2002 In 2002, 1 out of 7 hospital beds in America was a psychiatric bed In 1970, 1 out of 3 hospital beds in America was a psychiatric bed Source: NIMH and NRI

  8. State Mental Health Agency Controlled Expenditures for State Psychiatric Hospital Inpatient and Community-Based Services as a Percent of Total Expenditures: FY'81 to FY'05

  9. USA Today Front Page Thursday, May 3, 2007

  10. Smoking Obesity Suicide Substance Abuse Inadequate Medical Care People with Serious Mental Illness Experience 25 Years Lost Life: A Public Health Crisis

  11. 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.

  12. Rates of smoking are 2-4 times higher among people with psychiatricdisorders and substance use disorders. Kalman D, Morissette SB, George TP. American Journal on Addictions. 2005, 106-123.

  13. Smoking Prevalence among People with Mental Illnesses: Major depression 50 to 60 % Anxiety disorder 45 to 60 % Bipolar disorder 55 to 70 % Schizophrenia 65 to 85 % * 20% of those with schizophrenia started smoking at college age and many began smoking in mental health settings receiving cigarettes for good behavior. 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.

  14. 30%-35% of Mental Health Providers Smoke 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. 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 % ***

  15. Obesity, Metabolic Syndrome, and Diabetes Epidemic

  16. No Data Less than 4% 4% to 6% Above 6% Diabetes and Gestational Diabetes Trends: US Adults, BRFSS 1990 Mokdad et al. Diabetes Care. 2000;23:1278-1283.

  17. No Data Less than 4% 4% to 6% Above 6% Diabetes and Gestational Diabetes Trends: US Adults, BRFSS 2000 Mokdad et al. JAMA. 2001;286(10).

  18. Diabetes and Gestational Diabetes Trends: US Adults, Estimate for 2010 No Data Less than 4% 4% to 6% Above 6% Above 10% www.diabetes.org.

  19. Suicide Prevention • Suicide is the leading cause of violent deaths worldwide • In the United States • Number of deaths by suicide in 2004: 32,439(CDC WISQARS website and “Fatal Injury Reports”: http://www.cdc.gov/ncipc/wisqars) • Deaths per 100,000 population: 11.1 • An average of 1 person every 16.2 minutes died by suicide. • Many of them preventable through timely intervention. • National Suicide Prevention Lifeline: 1-800-273-TALK

  20. *Press 1 for Veterans Services

  21. Mental Illnesses are Chronic Illnesses that Impose Great Costs on Our Society • In 2002, mental illnesses contributed to $193 billion in lost productivity • More than the revenue of 499 of the Fortune 500 companies • By 2013, this figure is estimated to rise to more than $300 billion. • The World Health Organization has found that depression was the fourth leading cause of disease-burden in 1990 and by 2020 will be the single leading cause. • Indeed, mental illness is already the leading cause of disability for people between 15 and 44 in the United States and Canada.

  22. Mental Illnesses are Chronic Illnesses that Impose Great Costs on Our Society (Cont) • Data from the Agency for Healthcare Research and Quality (AHRQ) shows that expenditures for adults with a specific chronic condition AND a mental health condition greatly exceed expenditures for those without a mental health condition

  23. People with Serious Mental Illness Experience 25 Years Lost Life • People with schizophrenia die from diabetes at 2.7 times the rate of the general population • 2.3 times the rate from cardiovascular disease • 3.2 times the rate from respiratory disease • 3.4 times the rate from infectious diseases.

  24. Depression and Other Conditions • The likelihood of heart attack is four times greater for persons with depression than in general population; the likelihood of stroke is 2.6 times greater.

  25. Inadequate Healthcare and Insurance • Many people with mental health suffer from chronic conditions simply because they are not receiving appropriate healthcare. • People with mental illnesses are uninsured at twice the rate of the general population: 34% of people with mental illness have no health coverage at this point. • In other words, many people with mental illnesses are excluded from our nation’s porous healthcare system right from the start.

  26. Mental Health Is Essential to Health:Need for Prevention Approach • We must also approach prevention across the lifespan and work to provide the appropriate screens, starting with well-child visits that can identify the co-occurrence of mental health and chronic conditions. • It has long been a popular belief that mental illnesses begin in late adolescence or early adulthood. In fact, this is a misconception. The average age of onset for mental disorders is 14.

  27. Role of Trauma • We must develop a better understanding of role trauma plays in mental health conditions and then employ approaches that mitigate trauma’s effect. • We must understand and address maternal depression, the consequences it can have on a young child’s physical and emotional development, and the ways it can play out over the span of that young child’s life.

  28. Returning Veterans

  29. Barriers to Care and Mental Health Risk* 65 I would be seen as weak 31 My unit leadershipmight treat me differently 63 33 Members of my unit might haveless confidence in me 59 31 My leaders would blame mefor the problem 51 20 Screen pos Screen neg 50 It would harm my career 24 0 10 20 30 40 50 60 70 80 Agree or Strongly Agree, % Provided by Robert Ursano, M.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.

  30. Barriers to Care and Mental Health Risk*(cont’d) There would be difficulty getting time off work for treatment 55 22 It is difficult toschedule an appointment 45 17 I don’t trustmental health professionals 38 17 I don’t know whereto get help 22 6 Screen pos Screen neg I don’t have adequate transportation 18 6 0 10 20 30 40 50 60 70 80 Provided by Robert Ursano, M.D. Agree or Strongly Agree, % *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.

  31. 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 by Robert Ursano, M.D.

  32. NASMHPD President’s Task Force on Returning Veterans • Charge: To address issues related to the provision of mental health services provided to veterans (and their families) returning home from Iraq and Afghanistan. • Survey of States’ Services Members Commissioners • Nancy Rollins (New Hampshire)…Chair • Linda Roebuck (New Mexico) • Mike Lancaster (North Carolina) • Terri White (Oklahoma) Medical Directors • Alan Radke (Minnesota) • Jim Evans (Virginia) Division Representative • Joan Smyrski (Maine)

  33. Returning Veterans NASMHPD Initiatives • Addressing Issue at NASMHPD Commissioner Meetings (Winter 2007, Winter 2008, Summer 2009) • Veterans Administration on Suicide Prevention and Potential Partnering • SAMHSA Grant Announcement on Jail Diversion and Trauma – Priority Veterans

  34. Thank You!

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