Nine Recommendations to Increase Continuity of Mental Health Care for Schizophrenia Patients

Continuity of therapy is a vital component of quality care for people with serious mental illnesses and must be given more attention by consumers themselves, family members, advocates, providers, administrators, and researchers alike. At the moment, there is an important opportunity to develop a national consensus statement on the principles and practice standards that should form the basis of a continuum of therapy designed to provide realistic assurance that consumers can access vital medications when and where they are needed. Important strides have been made in identifying the specific factors which promote continuity of therapy – it is time to seize this important opportunity as yet another stepping stone to achieving the transformation of America’s mental health care system for the benefit of consumers and their families, our communities, and our Nation. A roundtable of mental health experts has developed a set of nine recommendations for enhancing continuity of medication therapy for persons with schizophrenia or serious mental illness, including schizophrenia. They are as follows:

Mental Healthcare Recommendation #1 -

Encourage collaborations between hospitals and community-based organizations. Use fiscal incentives to foster collaborations including the standardization of information and shared electronic health records.

Mental Healthcare Recommendation #2 -

Use a quality improvement approach to enhance continuity of therapy by benchmarking at the organizational level performance and outcomes standards regarding continuity of care.

Mental Healthcare Recommendation #3 -

Ensure all consumers have a level of care management for the transition from inpatient to community. Care management services should be reimbursable by all payers and the disincentives to providing it should be removed.

Mental Healthcare Recommendation #4 -

Hospitals and community providers should focus on the “Pull Model” of transition from inpatient to outpatient care. The Pull Model focuses on involving community-based providers in the transition planning process from the beginning. Provider organizations should focus on staff competency in engagement and strategies and motivational interviewing.

Mental Healthcare Recommendation #5 -

Accreditation standards should be aligned to address and improve continuity of therapy in treating serious mental illness. This may include developing standards to ensure evidence of an active process of care management and transition between levels of care, a quality review of the success of transition plans, and measuring engagement.

Mental Healthcare Recommendation #6 -

Consumers and their families should be educated about the benefits of maintaining their personal health care history. Ensuring that consumers have detailed information about their illnesses and treatment history will help ensure that providers have access to the information they need to provide appropriate care in a timely manner. The options here range from simple paper and pencil logs and medication histories to electronic records on memory sticks.

Mental Healthcare Recommendation #7 -

Consumer-driven recovery planning should include and the appropriate and necessary use of hospitalization. More thoughtful use of inpatient services could lead to a reduction in emergency room use and ultimately to a decrease in the number of hospitalizations.

Mental Healthcare Recommendation #8 -

Parties who collect data about mental health services and performance should share it with appropriate stakeholders in usable and timely ways. Many payers and public entities collect both population and individual specific information about mental health consumers and services. Population-based data should be shared with all stakeholders, including families and consumers to aid in enhancing the system of care.

Mental Healthcare Recommendation #9 -

There should be meaningful involvement of consumers and their advocates in all levels of system delivery and evaluation. Global involvement of consumers and their advocates in the care delivery process is essential. Examples include using peer specialists as part of a treatment team, active involvement in policy and planning, as well as involvement in developing and implementing performance measurement and evaluation.

Applying these Mental Healthcare Recommendations -

While we have learned that maintaining continuity of therapy has a positive impact on consumer outcomes, the barriers and other impediments to ensuring this continuum of care have been long entrenched in mental health and related care systems. An unacceptably high number of people with serious psychiatric issues – including schizophrenia, depression and bipolar disorder – are “falling between the cracks” in the transition between acute inpatient settings and the community causing harm and disruption in their own lives and those of their families and often bringing their recovery process to a halt.

A continuity of therapy initiative is likely to decrease inappropriate use of emergency room services by consumers with schizophrenia or other serious mental illnesses by assuring consistency in the disease management approach used by all community provider organizations. Both of these likely outcomes of continuity of therapy provide cost reductions for the hospital and cost offset for the investments in continuity of therapy initiative and related therapies.

In addition, the continuity of therapy initiative provides the community hospital with another very tangible benefit. The continuity of therapy initiative provides the relationships, process, and infrastructure for an overall discharge planning functionality for all consumers with mental illnesses. This discharge planning functionality is a new, and critical, element in modern behavioral health standards that began in 2007.

The Quiet Room: A Journey Out of the Torment of Madness

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Product Description
Schiller’s gripping, heart-rending and ultimately triumphant story of her journey into madness and back to reality is told through the voices of Lori and her family, friends and doctor, and captures a rare, astoundingly vivid view into the inner life of a schizophrenic. “A stunning story of courage, persistence, and hope.”–Publishers Weekly…. More >>

The Quiet Room: A Journey Out of the Torment of Madness

Optimism for Mental Health

• Manage depression or bipolar proactively
• Find the triggers of your episodes
• Recognize early warning signs and symptoms
• Discover health strategies that work for you
• Take firm control of your mental health

Product Description
Optimism is a Mood Chart application that helps you develop strategies to manage depression, bipolar and other physical or mental health problems. Use it to discover the triggers of illness, the warning signs of an episode, and strategies that help you to stay well.

Optimism helps you to be proactive. Charts and reports form a continuous feedback loop, helping you to better understand your health and the things that are helping you or causing problems. All fields … More >>

Optimism for Mental Health

How State Budget Cuts Impact Continuity of Mental Health Care

Continuity of care between the inpatient and outpatient settings continues to be a challenge. Current hospital payments assume that hospitals are actively involved through discharge and the transition to outpatient settings and advocating for payments for outpatient providers to assist in this process is viewed as duplicative. This undermines mental health care providers’ ability to smoothly transition clients between service settings.

Meeting the credentialing requirements for program services and mental health professionals has posed new challenges. Community behavioral health organizations employ professionals that may not meet private insurers’ credentialing standards (for example, 3 years of post-licensure experience). Community providers have addressed this through contractual arrangements in which quality assurance and supervision requirements substitute for these credentialing standards. Services are billed under a supervisory protocol in which the supervising professional’s national provider identifier is used.

Additionally, some programs offer services that rely on a combination of funding sources such as county, state, and private insurers. In these situations, counties sometimes want to limit private insurance clients’ access to these programs because a portion of the overall program is covered by the county.

Impact of State Budget Cuts on Mental Health Care -

In a dramatic turnabout that may foreshadow dilemmas faced by other states, the governor of Minnesota vetoed funding for the state’s mental healthcare program. The legislature would have extended the program for several months, as a compromise was negotiated to retain elements of coverage for the state’s mental health population – a hospital uncompensated care fund, medication/pharmacy, and “coordinated care delivery systems.” In the system, an accountable hospital-centered program paid a fixed amount to cover about 40% of the state’s mental illness population who elected to participate. As there is no reimbursement for outpatient clinic and all non-hospital services, providers and consumers now are scrambling to seek disability determination or enroll in Medicare type coverage after the six month state mental illness coverage enrollment period ends.

While these cuts are only effective as of June 1, 2010, it is expected that they will result in increases to the uncompensated care burden on hospitals and community safety net providers.

How Do We Minimize The Impact of Budget Cuts on Mental Health Care?

Many not-for-profit membership organizations representing community mental health and other service provider agencies throughout Minnesota have been working in coalition with national mental health groups on advocacy related to the state’s mental health program changes. Initially, advocacy efforts were focused on encouraging the state legislature to vote in support of expanding the state Medicaid program early to receive additional federal funding (as provided for in the national healthcare reform bill). Unfortunately, this proved to be politically untenable in the immediate future; however, a measure was passed to allow the governor to use executive authority to expand Medicaid coverage for mental illness patients.

While being actively involved in this advocacy process is vitally important to the community behavioral health system, national mental health advocacy medicaid organizations and their members are also evaluating ways in which they can optimize their business practices to meet this changing budgetary reality. Among other strategies, community behavioral health providers are working to develop partnerships with community hospitals to reduce the number of avoidable emergency department admissions and ease the transition from the inpatient to outpatient settings, supporting clients through the disability determinations process so they may become eligible for Medicaid as quickly as possible, and raising funds that will help to cover the cost sharing requirements for state sponsored mental health care and the enrolled clients that are unable to pay.

Through this two-pronged approach that includes both advocacy and pragmatic business considerations, it is hoped that the community behavioral health system will be able to develop new cost-effective ways of delivering services that will be well-positioned to withstand funding changes while taking advantage of new opportunities made available through national and state health care reform initiatives.

School Based Mental Health Services Reduce School Violence

We live in a complicated world requiring complex skills. We must prepare our children to cope and to compete. They need reading, social studies, science and math more than ever, but they also need social skills, problem solving, superior reasoning and good mental health. There is a societal need to reduce the incidence of violence in our schools, as well.

When children and teens are focused on problems at home or within themselves, they often do not do well in school. School success and good mental health are intrinsically tied together. Additionally, school success and good mental health are linked to life success. Identifying those youth who are in need of help can reduce suffering and improve mental health, school success, and life success. Good mental health aids development, learning, interpersonal relationships, and the ability to cope with stress more effectively.

Approximately 1 in 5 children & adolescents (20%) experience the signs and symptoms of a mental health disorder during the course of a year. These children are estimated to have severe emotional or behavioral problems that significantly interfere with their daily functioning. Yet, less than one-third of the children under the age 18 with a serious disturbance receive any MH Services. Often the services they do receive are inadequate or inappropriate (Children’s Defense Fund). Ten percent of children in any given classroom (3/30) are ready to learn at the curriculum level (Dr. Adleman & Dr. Taylor UCLA School Mental Health Project).?Only 16% of all children receive any mental health services. Follow through for children receiving mental health services in school is much greater than those referred to community services. Of the 16% that receive MH services, 70-80% receive that care in a school setting (healthinschools.org), yet less than 10% of all school districts in the United States currently have an established School Based Mental Health Program (Center for School Mental Health Assistance, Dr. Mark Weist 2001, University of Maryland).

To assess the effectiveness of school based mental health (SBMH) services in reducing emotional, school, home, and behavioral problems of youth, Robert Schmidt, MA and Kathryn Seifert, Ph.D. collaborated on the evaluation of outcomes for a SBMH program for a rural mid-Atlantic School district. Coordination of mental health services with educators, Department of Social Services, the Department of Juvenile Services, and the Development Disabilities program contributed to the program’s success.

The project began in 1999 with a Federal grant to the school district and the project is ongoing. Youth were referred to the project from teachers, guidance counselors, parents, student self-referrals and other agencies such as the Departments of Social Services and Juvenile Services and Law Enforcement. The student’s scores on the Devereaux, BASC, CARE and several school measures such as absenteeism, disciplinary referrals, violence related suspensions, and other suspensions were measured at the beginning of services and at the beginning and end of each school year.

From 1999 to 2004, 36% youth were referred because of symptoms of depression, 26% because of family problems, and 24% because of behavior problems. Examples of reasons for referral to the program included: crying in class, child can’t stay focused, student found out mom is terminally ill, youth’s parents going through divorce, and recent sexual abuse. There were 84 referrals to the program in 1999, compared to 437 students in 2002 and 239 students in 2003. Peak referral times were in October and February. Youth in the transition years of sixth and ninth grades were referred to the program most often. In 2000, 2,132 mental health sessions were provided, in contrast to an amazing 15,763 sessions in 2003.

A group of 632 students who participated in the program showed significantly improved attitudes toward teachers and school, mental health symptoms, and self-esteem during and after services. Students participating in SBMH in years one and two had significantly better school attendance (56 and 57% increase) when compared to non-participants (66 and 59% decrease). Additionally for the group of participants, absenteeism increased 44% before participation and decreased 53% during participation.

Students had a significant (40%) decrease in disciplinary referrals when compared to non-participants (20% decrease). Participants in years one and two had a significant decrease in suspensions (32% and 27%) from school when compared to non-participants (33 and 16% increases). Parents reported that their children were having significantly fewer problems after receiving services. Youth self-reported significantly improved commitment to school, interpersonal relationships and self-esteem, as well as fewer stress related problems. Students reported significantly reduced school maladjustment and clinical maladjustment and improved attitude toward parents and emotional well-being.

Evaluation of the success of the program revealed several key components. One important component was having a central school/mental health coordinator to be an organizer, ombudsman, problem solver, program evaluator, and coordinator of the two systems. Additionally, the mental health service must be an integral part of the school system, not just an adjunct or add-on. Mental health staff need to communicate and attend meetings with school personnel. Mental health professionals can provide workshops and consultation to teachers, guidance counselors, and administrative staff.

Funding for the project came from mental health third party billing and grant funding. Supplemental funds allowed mental health professionals to attend meetings, consult with school personnel, and provide services for children and youth who do not meet medical necessity criteria of their insurance companies. It is also important to include families as an essential part of the program.

In a time when all programs are struggling to cope with funding cuts, collaborative programs, such as this one can make services more efficient and cost effective. Many families of troubled youth are involved in more than one service, in addition to the school. Coordination of multiple services is beneficial to the families and helps improve outcomes for youth.

This project demonstrated that school based mental health services improved student well-being, behavior and school success, while showing a significant decrease in violence and other behavior problems at home and at school. The study is ongoing and a second site has been added.

The Thinking Nurse Board Games: Mental Health Nursing

• In response to educator needs, this game presents new and compelling modalities for mental health nursing.
• Provides a stimulating forum for student discussion.

Product Description
More than just a board game, the Thinking NurseTM develops and uses instructional strategies to promote higher-level thinking. It offers your students an enjoyable way to review nursing content, prepare for the NCLEX® exam, apply the nursing process by formulating nursing diagnoses, goals, and outcome criteria. Your students can apply nursing interventions based on brief patient scenarios.

There are two types of game cards: “question” cards and “patient scenario” … More >>

The Thinking Nurse Board Games: Mental Health Nursing

Mental Health Insurance and Health Plan

There are many facets to the world of mental health, especially when it comes to health insurance and finding adequate coverage for a variety of afflictions and disorders. We’ve put together some answers to some of the more common questions revolving around these topics for you below.

Do most health plans include mental health coverage? The answer, simply put, is yes. The vast majority of insurers and health plans cover at least a limited amount of mental health care.

According to a recent employer survey published in the journal Health Affairs:
•91 percent of small firms (10-499 employees) and 99 percent of large firms offer mental health and substance abuse coverage in their most used medical plans.
•Mental health and substance abuse coverage was included in 87 percent of indemnity plans, 88 percent of HMOs, 97 percent of Point of Service (POS) plans and 93 percent of Preferred Provider Organizations (PPOs).

It is commonly acknowledged today, in 2006, that most employees who have employer-based health insurance have access to mental health coverage, and many of the employees who don’t have coverage have simply chosen not to join an employer’s plan that includes mental health services.

Does mental health coverage cost more? Yes, this is generally the case. There are limits to mental health coverage and the reason why most employers impose limits is due to cost. Estimates vary widely of how much more mental health coverage costs. Here are some results from some studies:

•A 1998 study sponsored by National Advisory Mental Health Council (NAMHC) Parity Workgroup, a division of the federal National Institute of Mental Health, estimated that mental health services would add less than 1 percent to the cost of a health insurance policy for an HMO.

•A 1998 study by Mathematica estimated a 3.6 percent increase across all plans, with a range of 0.6 percent increase for HMOs up to a 5 percent increase for fee-for-service plans.

•A 1997 analysis by the actuarial firm Milliman & Robertson for the National Center for Policy Analysis, examining the cost of a typical mental health mandate (not specific legislation), concluded that mental health services parity legislation tends to drive up costs by 5 percent to 10 percent.

With regard to mental insurance in general, how do insurance companies treat mental illness? Insurance companies tend to be somewhat wary of mental health claims due to the increase of fraudulent claims. When Medicare looked for fraud in the community mental health centers last year, it barred 80 of them in nine states from participating in the program.

The Health Care Financing Administration (HCFA), which administers Medicare, knew something was amiss when the average yearly cost for each senior getting mental health services jumped from $1,642 in 1993 to more than $10,000 by 1997.

Medicare administrator Nancy-Ann DeParle contended at the time that 90 percent of the patients had no mental illness serious enough to qualify for special treatment.

That being said, it’s straightforward to understand why there is trepidation on the part of health insurance providers.

What mental conditions are typically covered, and not covered by health plans? Generally speaking, a health plan pays for only those services included in the plan’s list of covered services. In the case of mental health services, inpatient and outpatient treatment are most often covered by health plans.

However, there is a continuum of services between inpatient (mental health clinic) and outpatient care that effectively treat many mental disorders and are often more cost-effective than inpatient care at a mental health clinic.

These intermediate services include nonhospital residential services, partial hospitalization services, and intensive outpatient services such as case management and psychosocial rehabilitation. Psychosocial rehabilitation includes pharmacologic treatment, social skills training, and vocational rehabilitation.

Such services are covered by approximately half of employer-sponsored health plans.
Prescriptions. Are they covered? Coverage of prescription medications is also important in providing access to treatment for mental health disorders. And, on a positive note, Prescription medications are nearly always covered by health plans (U.S. Department of Labor, 1996; 1998), but this coverage is sometimes limited by formulary restrictions.

Check with your healthcare provider for the exact details on what applies to you and your family with regard to your specific circumstances.

Alternatives to Doing Your Own Mental Health Billing

Whenever a mental health professional starts his or her practice, they usually do mental health billing on their own. This can be a good thing at first because learning more about the business they are in allows them to grow as professionals. However, after they have seen how mental health billing works, they have to take into consideration one important aspect: is it to their advantage to keep doing mental health billing themselves?

The answer is no. By continuing to do their own billing, mental health professionals will only spend more money than using other services, they will waste precious time that can be put to better use and, on the long run, they will also lose patients. So, what are their alternatives?

Well, they could hire people to do mental health billing for them or they could use a mental health billing service.

Hiring staff to do mental health billing is the first option. However, this alternative is only effective on the long run. First of all, the staff must be accommodated and if your practice does not have enough room, this could result in extra expenses for you. Secondly, if you choose to hire inexperienced people, you will pay them less, but you will invest more money in their training. Moreover, you will be also investing time in your new staff and before they have reached a level of experience you are comfortable with, you would have spent a considerable amount of money, not to mention you would have wasted a lot of precious time. On the other hand, you could hire an expert to do mental health billing for you. In this case, the wage you would have to pay him or her is far greater than minimum wage. Furthermore, if you decide to hire your own people to do mental health billing for you, you will also have to comply with employees/ employer laws and again spend money and time on their payrolls.

Using a mental health billing service is the other alternative. This is a far better choice. First of all, by a using health billing service, you can control the amount of money you spend on billing. Payments can be made either per service, as percentage or per claim. Second of all, you receive the insurance money a lot faster. Most of the times, mental health professionals refuse to work with insured patients because of the paperwork involved. By using a mental health billing service, everything is done on the computer, using flexible software. This way, the mental health professional receives his or her money in a timely fashion and, subsequently, increases the number of the patients by receiving more insured clients. Last but not least, if they choose to use a mental health billing service, they will have an experienced person working for them. No training will be required and no time will be wasted on trying to achieve a desired level of expertise.

Mental health professionals must know how to make the bet use of their time and money if they want a successful business. Using their own staff may be more comfortable for them, but business is not about comfort, it is about moving ahead. In this case, a mental health billing service is the best choice for every mental health professional’s practice.

For more resources about mental health billing or even about Mental health billing service please review this website http://www.mymedicalbillingservice.com

The Importance of Pursuing Mental Health Integration

Why Pursue Mental Health Integration?

It is the right thing to do: The NCCBH vision statement provides the foundation for our work: We are committed to creating and sustaining healthy and secure communities, achieved through a system that holds the needs of consumers paramount, regardless of their ability to pay.

Vital to this commitment is a network of organizations and advocates promoting services of unparalleled value.

NCCBH members primarily serve public sector consumers, those with severe and persistent mental illness or serious emotional disturbance-the needs of this population are often overlooked in primary care and integration planning. We must assure that their needs as well as the needs of the broader community are appropriately addressed.

Many people in the broader community now receive their behavioral healthcare in a primary care setting, and the gap between the medical and behavioral healthcare systems must be bridged: As noted by Robin Dea and many other commentators, there is:

“evidence that many, if not most, people coming into primary care are being treated for psychosocial problems, not organically based medical disease . . . evidence of medical cost offsets from treating behavioral health problems presenting as physical health problems in the primary care setting . . . the assumption that if adequate detection of early stage psychiatric illness took place in primary care, there would be some prevention of patients going to more severe episodes of major psychiatric illnesses . . . and primary care is where most people who have behavioral health problems are in fact seen.”

Some of the important findings from the research field include:

-The Epidemiologic Catchment Area (ECA) Study and articles based on this survey data, reported the finding that about 50% of care for common mental disorders was delivered in general medical settings. However, many subsequent studies have shown that these disorders may be undiagnosed or under-treated.
-Screening systems, treatment guidelines and provider education in primary care are necessary but not sufficient steps to ensure a difference in outcomes.
-Collaborative and stepped care has been shown to achieve outcomes that are better than “usual care”.

There is the opportunity for quality improvement of care within the primary care and specialty behavioral healthcare settings: Studies have shown that many people with depression stop taking their medications before the minimal time required to effectively treat an episode of depression. Patients at Group Health Cooperative who initiated medications for depression with their primary care physician and received targeted stepped up care and relapse prevention support were significantly more likely to adhere to adequate dosages of medication and to demonstrate a greater decrease in depressive symptoms.

Application of research findings such as these through adoption of evidence-based practices in both primary care and specialty behavioral health (BH) settings will result in better outcomes for consumers.

With the publication of Priority Areas for National Action: Transforming Health Care Quality, the Institute of Medicine’s 2003 follow up to Crossing the Quality Chasm: A New Health System for the 21st Century, a major opportunity and challenge has appeared for the public mental health system.

The Quality Chasm recommended the systematic identification of priority areas for national quality improvement; Priority Areas proposes twenty areas for transforming health care nationally. Included in this list are major depression (screening and treatment) and severe and persistent mental illness (focus on treatment in the public sector).

Their inclusion as priority areas, as well as the findings in the Interim Report from the President’s New Freedom Commission on Mental Health, with its observation that the system is “fragmented and in disarray-not from lack of commitment and skill of those who deliver care, but from underlying structural, financing and organizational problems” suggests that the time for new strategies is at hand.

Many people being served by public behavioral health services need better access to primary care: A rationale less frequently articulated for integration is that the specialty BH system, especially the public sector focusing on the severe and persistent mentally ill adult population (SPMI) and seriously emotionally disturbed (SED) children, serves a disabled consumer population with healthcare needs that are frequently under-addressed due to difficulties in obtaining medical services.

Most state Medicaid waivers related to coverage for physical healthcare have focused on enrollment of the TANF population into Medicaid managed care plans, leaving the disabled Medicaid population unable to adequately access care, or in better situations, reliant on “safety net” providers-community health centers (CHCs) or county delivered health services.

Community health centers serve people who need better access to behavioral healthcare. These “safety net” providers serve a broader scope of patients than just the Medicaid population. But many states have implemented mental health Medicaid waivers that focus the public mental health system on the SPMI/SED and Medicaid populations, with minimal levels of support for non-SPMI/SED or uninsured populations. Often there is not a good match of target populations between the two systems. If the Medicaid mental health program also has a highly managed service authorization and payment methodology, there may be additional barriers to reimbursement for mental health services.

This has led to frustration for “safety net” healthcare providers because they have difficulty obtaining behavioral health services for their non-SPMI/SED or uninsured patients. In a recent survey of CHC medical directors, 80% indicated that cost is the main barrier to behavioral health care for their uninsured populations. The recent financing and development of behavioral health services in CHCs addresses this frustration and is just the latest in a series of efforts to acknowledge that a large proportion of the population gets their behavioral health services in primary care.

Because behavioral health clinicians are a resource for assisting people with all types of chronic health conditions: Yet another reason for integration is the potential contribution of BH clinicians regarding behavioral and lifestyle change: providing interventions targeted at better management of chronic disease, supporting and “leveraging” the time of primary care providers through disease management programs.

Disease management activities focus on several areas: early identification of populations at-risk for costly chronic disease (e.g., asthma, diabetes), care interventions that utilize evidence-based practices, education-intensive orientations that focus on both patient and provider, care management and a coordinated approach across multidisciplinary treatment teams, and a method for systematic data collection that measures clinical and cost-effectiveness. Large organized healthcare systems, such as Northern California Kaiser-Permanente, implement their major disease management programs with specifically assigned nurses as care managers and educators.

However, many physicians in individual or group practices do not have access to this level of support unless they are in the network of a health plan with active disease management programs. In markets where primary care and multi-specialty groups have accepted accelerated risk, disease management approaches will be especially value-added.

We are in a time of significant public policy activity regarding financing of the national healthcare system and the uninsured population. As we approach the 40th anniversary of the founding of the community mental health center movement, the dialogue has returned us to our public health beginnings-serving the needs of a population.

The Health Resources and Services Administration (HRSA) Primary Care Integration Initiative is currently being implemented across the country. The HRSA initiative includes: identification of system issues related to integration and the development of related strategies; development of a service manual for CHC behavioral health services; development of BH intervention models for CHCs; and grants for establishing BH services in existing CHCs.

Newly funded CHC sites will be expected to provide dental, mental health and substance abuse services, either directly or by subcontract arrangements. CHCs are in the process of decision making about building their own BH services or contracting for BH services, as they prepare their grant applications. (The NCCBH website, www.nccbh.org, has a Primary Care Integration Resource Center with more details about the HRSA process.)

At the same time that HRSA is putting new BH resources into CHCs, reports are emerging from many states indicating that the public mental health system is funded at somewhere around half the level that is needed. In the private sector, the relentless downward pressure on behavioral health PMPMs has also reduced overall system resources, shifting cost from the private sector to the public sector.

Reports such as these were released prior to the current fiscal crisis in state Medicaid programs; rather than addressing the shortfalls, there are significant new reductions in BH services in many states. And, the implementation of managed care methods for Medicaid have made it difficult for some community based BH providers to continue to enact their mission of serving the needs of the population, regardless of ability to pay.

The implications for system-wide duplication and competition for the scarce resources of BH staff and funding, as well as the opportunity to improve consumer access to both health and behavioral healthcare services, suggests that collaboration is a priority at the national, state and local levels. Good public policy will work at sustaining, supporting and requiring collaboration between the two “safety net” systems of community mental health centers and community health centers.

The conceptual model proposed in this paper can become the basis for HRSA grantees to work with their partners in the public mental health system to fully define working relationships and collaboration on behalf of consumers of care.

In summary, the reasons for integration are grounded in the desire to improve access to both primary care and behavioral health services; ensure that there are evidence-based practices as well as consistent communication and coordination of clinical activities (especially medication management-a key concern of consumers) among the providers serving any single individual; wed the skill sets of primary care physicians and BH clinicians in order to better manage chronic health issues; and, participate in and shape the public policy debate regarding how services should be organized, delivered and financed in ways that ensure that needs of public sector SPMI/SED consumers and the broader community alike are met.

Essentials of Psychiatric/ Mental Health Nursing

Product Description
Whether it an entire course on psychiatric nursing or integrating these principles into an existing course, this is the text that concise, engaging, and informative. It offers an evidence-based, holistic approach to mental health nursing in a streamlined format that explores nursing diagnoses for both physiological and psychological disorders. It the psychiatric nursing text that students actually read, understand, and use.Completely revised and updated throughout, … More >>

Essentials of Psychiatric/ Mental Health Nursing

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