International Exchange Edition
August eSolutions: International Exchange Edition
Feature article: A Summer Trip Abroad: Integration Overseas
Quick Tips: Start a Discussion about Mental Health in your Community
Featured resource: Financing Health Homes paper
Individuals across the globe face similar health challenges everywhere, and providers must meet these challenges in creative ways. We often look to other behavioral health and primary healthcare providers, states, and health systems to see what primary care-behavioral health integration models are producing the great outcomes we’ve come to expect.
We may have different health system designs, but what can we learn from our colleagues overseas? And what can we replicate here in the US?
Fran Silvestri, President and CEO of the International Initiative for Mental Health Leadership (IIMHL), and Janet Peters, New Zealand liaison for IIMHL, offer a peek into the latest trends and innovations in primary and behavioral healthcare integration in three countries.
England: Increasing Access in Primary Care
Improving Access to Psychological Therapies (IAPT) is a National Health Service (NHS) program rolling out services across England offering interventions approved by the National Institute of Health and Clinical Excellence for treating people with depression and anxiety disorders. Launched in October 2008, the initiative supports services to expand access to talking therapies in primary care across the NHS system.
A report of the first three years shows that the initiative has seen more than a million people using the new services, recovery rates are in excess of 45%, and economic gains from more than 45,000 people moving off sick pay and welfare benefits. Their workforce development focus has added nearly 4,000 practitioners newly trained in cognitive behavioral therapy (CBT) and other therapies. In the next three years, they plan to train another 2,000 in order to keep up with service demand, as primary care providers currently struggle with significant wait lists.
IAPT expects this approach will save the NHS approximately £272 million ($423.3 million US dollars) by 2016 through reductions in healthcare usage, including decreases in appointments with general practitioners, inpatient bed days, and long-term repeat prescription refills.
In February 2011, IAPT released Talking Therapies: a four year plan of action and No Health Without Mental Health, which expanded the scope of the program to children, young people and people with long-term physical conditions, medically unexplained symptoms, or severe mental illnesses. The plan aims for a complete nationwide roll-out of psychological therapy services for adults by April 2015. IAPT implemented an outcomes monitoring system that collects data from more than 200 service locations. Public access to this data set is expected to help provide insight to improve services.
Ireland: Shared Care
In 2011, Ireland’s health services formed a working group to propose programs to improve access, cost effectiveness, and quality of care for their users. The group developed the policy statement, A Vision for Change: Advancing Mental Health in Ireland, in response to this call to action. The Irish government allocated €6 million ($8 million US dollars) to the initiative, which aims for individuals to have timely, affordable access to psychological therapy.
Ireland’s approach is a model of shared care that involves collaborative service delivery and information sharing between primary and community mental healthcare providers. Their report, released in 2012, describes the model and outlines the specific recommended actions providers can take. Recommendations include training staff, creating a team coordinator to ensure all providers communicate, development of standardized electronic and referral processes, and outlining measurable goals for shared care. The report also shares five case studies of providers throughout Ireland that have implemented innovative shared care programs.
Although the initiative is relatively new, Ireland hopes it creates a foundation to help individuals access quality mental healthcare in both primary care and specialty services, as needed.
New Zealand: Training Primary Care Staff
Affected by the current global economic climate, Te Pou, a New Zealand charitable organization that supports and develops the mental health, addiction and disability workforces, sought to transform the way mental health services are offered without needing a significant investment of government funds. Their solution was to train primary care professionals to provide certain talking therapies, particularly CBT.
The approach, outlined in Talking Therapies: Where to Next?, promotes a stepped care approach to implementing talking therapies that spans primary and specialty behavioral health care. The plan specifies five tiers of service, each detailing the recommended service provider, treatment(s), and setting, depending on the severity of the mental health challenge the service user presents. Service user need is matched to the appropriate tier, or tiers, through a preliminary assessment. This model does not assume that all people receive tier one first or that the tiers must be accessed in order. Stepped care is an efficient way of making use of limited resources. It provides a model for integrating talking therapy provision across primary and secondary services.
As a part of this initiative, Te Pou also produced a series of awareness materials for both providers and the general public, Guides to Talking Therapies, to encourage individuals to seek help and to instruct them on how to do so, as well as to provide staff with more information on the services. Provider guides focus on special underserved populations, including older adults, refugees, and individuals from diverse cultural backgrounds.
As countries continue to explore new models to provide integrated care, we can learn from the findings and unique approaches of our colleagues abroad. IIMHL offers a forum for this kind of information exchange, as a unique international collaborative that focuses on improving mental health and addictions services. IIMHL is a collaboration of eight countries: Australia, England, Canada, New Zealand, Republic of Ireland, Scotland, Sweden, and the U.S. IIMHL organizes systems for international networking, innovation sharing and problem solving across countries and agencies. The overall aim is to provide better outcomes for people who use mental health and addiction services and their families. Become a member and learn more at www.iimhl.com.
What other programs and initiatives abroad do you know of? Email us at firstname.lastname@example.org to share innovative programs and research with us. CIHS tracks information and research related to integration abroad on our international web page.
Ideas and best practices can come from across the world or at home. Engaging with others throughout your community will help to identify what you can do to impact mental health challenges in your community. Here are some tips on how to start a conversation among your community leaders.
- Host a meeting. Starting a conversation begins with getting members of the community together. Invite stakeholders from across the community to participate. Meeting groups are ideally designed for 8-12 participants; larger groups can break into smaller groups for discussion.
- Share Personal Experiences. Explore what mental health means to your community, and make a connection with individuals to understand the values and perspectives from the community.
- Discuss challenges. Are there any particular challenges your community sees frequently? What risk factors for mental illnesses stem from environments within your community, particularly for young people in your area? What factors prevent change to these challenges?
- Explore Responses. What can your community do to address mental health challenges and risk factors? What are specific areas you can address locally?
- Create a Plan. Ask each member to suggest a solution, write each down, and then review as a group to determine the priorities and solutions the community is willing to take on.
These tips come from SAMHSA’s Community Conversations about Mental Health – Discussion Guide. Read the full guide on creating community conversations.
A new report from CIHS, Financing and Policy Considerations for Medicaid Health Homes for Individuals with Behavioral Health Conditions: A Discussion of Selected States’ Approaches, reviews the policy considerations and options for states and providers to establish reimbursement methodologies and payment rates for health homes.
The Atlas of Integrated Behavioral Health Care Quality Measures was just released! Created by the Agency for Healthcare Research and Quality (AHRQ), the Atlas is a framework for understanding measurement of integrated care. It includes a list of existing measures relevant to integrated behavioral health care, and the Atlas organizes the measures by the framework and by user goals in order to facilitate selection of measures.
The National Council for Behavioral Health, in collaboration with the University of Colorado’s Behavioral Health and Wellness Program, is hosting Tackling Tobacco in Behavioral Health Settings, a free training for behavioral health clinicians, peer support professionals, administrators, and others interested in reducing tobacco-related illness among individuals with mental health and substance use disorders. The half-day training will be held on Sunday, September 15, from 1:00–5:00pm at the Hyatt Regency Hotel in Washington, DC. Register here.
Substance Use in Older Adults: Screening and Treatment Intervention Strategies is a 3-hour self-paced course developed by the Pacific Southwest ATTC Regional Center which reviews alcohol and prescription medication use among older adults and highlights the need for routine screening, assessment and specialized interventions for this vulnerable population.
States developing integrated care initiatives have been participating in a series of Study Hall Calls with Centers for Medicare & Medicaid Services, as well as state staff and external subject matter experts to discuss issues related to program design and implementation. Download presentations from recent calls on marketing and member materials, enrollment guidance, and three-way contracts.
Health Habits Screening is an online, anonymous, self-administered screening program, with audio and video prompts, that primarily screens individuals for potentially harmful drinking patterns, but includes additional questions on nutrition, smoking, and exercise behaviors and provides immediate, tailored feedback. Individuals can print out feedback, as well as a one-page provider report to share with a medical provider.
Clinicians and others who want to intervene with tobacco users have a growing array of tools to help them in their work. The Smoking Cessation Leadership Center’s Catalogue of Tools is collection of these resources. The tools, many of which were developed over the last few years, come from a variety of health professional organizations and individuals dedicated to tobacco cessation. Most of the tools are free and a few can be purchased for a nominal cost. They cover a wide spectrum as well, including coaching, medicines, and social support.
The Institute for Wellness and Recovery Initiatives at Collaborative Support Programs of New Jersey offers the Words of Wellness newsletter to help people achieve and maintain wellness. The August issue includes tips for finding a job, the effects of routines and habits on wellness, and personal wellness and employment.
PBHCI grantee the Centers for Families and Children (OH) launched The Resource Center Library to host a range of health and wellness resources, including condition overviews, best practices, guides, tools, and videos to help individuals, caregivers, and communities get healthy and stay well.
More and more consumers are finding opportunities to serve on advisory boards and committees, where they can truly impact mental health policy. A technical assistance guide from the National Mental Health Consumers Self-Help Clearinghouse explains how to become an effective member of a board or committee.
Integrating Behavioral Health in Primary Care: Lessons from Health Centers (FQHCs)
Thursday, September 19 1:30pm Eastern/10:30am Pacific
Integrating behavioral health services into a primary care practice involves elements such as adjusting staff roles, workflows, and getting significant stakeholder buy-in. Two health centers, Tillamook in Oregon and Manet in Massachusetts, will share their lessons learned in establishing integrated care, including what they gained regarding leadership, partnership development, business strategies, and program sustainability. Their approaches are applicable to a variety of safety-net providers trying to incorporate behavioral health services into their agency. Over the past year, each of these centers participated in the behavioral health integration learning community supported by the SAMHSA-HRSA Center for Integrated Health Solutions, and jointly run with the National Association of Community Health Centers.