Mental Health Matters: Importance, Integration, and Intervention Opportunities

(Note: this guest piece was written by Elizabeth Archer-Nanda, DNP, APRN, PMHCNS-BC. Elizabeth is the manager of the Behavioral Oncology Program at Norton Healthcare, which cares for the emotional and mental health needs of oncology patients and their families. In this piece, she shares her reflections from the KHC 2019 Annual Conference, which she attended.)

Last month, the Kentucky Health Collaborative hosted their fifth annual conference focusing on opportunities to create high value behavioral healthcare across the region. The room was full of community and national partners and offered comprehensive discussions around closing the gap on how to approach the treatment of mental health and substance use disorders. Speakers gave personal reflections on the impact mental illness has on individuals close to them as well as prospects for how purchasers and stakeholders may address foundational barriers to quality mental health care.

Paul Gionfriddo, President and CEO of Mental Health America, Inc. provided an overview of mental health services in the U.S. from 1970 to current day by poignantly comparing and contrasting his family’s experiences navigating mental health services for his son, Tim, versus medical care for his daughter, Larissa.

Although Larissa ultimately died due to breast cancer at age 34, her health journey was met with opportunity for personal growth throughout her four-year illness. Tim’s health journey, however, which began at age five and now spans close to three decades, has been riddled with years of pending diagnoses, deteriorating mental health, homelessness, and – on more than one occasion – imprisonment.

Following Gionfriddo’s talk, Mike Thompson highlighted that for mental health care to be truly accessible, barriers must be removed, including:

  • eliminating obstacles to provider credentialing,
  • improving, vastly, the mental health provider reimbursement models, and
  • Increasing incentives to attract psychiatrically trained providers to work within health systems where the majority of patients are receiving care.

The impetus for these recommendations is solid. The prevalence of mental health conditions far exceeds the number of available psychiatric providers trained to treat these conditions. The healthcare system must begin to think creatively regarding how to care for individuals with mental health conditions. Only 20 percent of individuals with co-occurring mental health conditions will receive specialty mental health and/or substance use care intervention. Meanwhile, approximately 21 percent receive care through routine primary care; this leaves the remaining 59 percent of individuals not to receive care at all (Robinson & Reiter, 2016). The ability to weave the care of mental health conditions throughout routine care provides an enhanced opportunity to promote earlier intervention and adequate treatment for co-occurring mental health and substance use conditions.

Both presenters reinforced the 2017 position statement by the American Psychiatric Nurses Association that “whole health begins with mental health.” Specifically, the negative impacts of mental health and substance use on our productivity and wellness as a nation are widely known, yet movement toward early intervention for mental health conditions remains scarce in most communities.

This is reflected in the research.

Approximately 56 million American adults experience mental health or substance use conditions each year, with three-quarters of all chronic mental health conditions beginning by age 24 and the first intervention occurring almost 10 years later. Among individuals affiliated, 68 percent have co-occurring medical conditions, as was discussed by Intermountain Healthcare’s Brenda Reiss-Brennan at last year’s KHC Annual Conference. Further, worldwide depression is the leading cause of disability and by 2020 it is estimated that there will be one death by suicide every 20 seconds. Lastly, the cost of (untreated) mental health and substance use conditions in the U.S. is equally staggering at $201 billion annually – exceeding all other conditions.

A shift must occur in which we build systems capable of caring for a whole person’s health needs at the onset of symptom distress across their healthcare journey, rather than providing reactive crisis related care intervention. An individual’s health relies on their mental health to fully embrace the challenges presented in life. The ability to access care that embraces mental health as part of personhood is needed in order to truly promote health and wellness.

Gionfriddo’s honest account of two of his children’s journeys highlighted the disparity experienced among those with mental illness. He urged attendees to consider what might be if mental health conditions were met with the same resource allocation as other illnesses. What might happen if instead of attempting to “rescue” individuals from already debilitating symptoms of mental illness, earlier intervention strategies were employed to treat individuals before advanced stages of mental illness?  

As a psychiatric advanced practice nurse embedded within an oncology setting, we widely recognize the disadvantage of a later stage cancer diagnosis. The campaign launched by Mental Health America to treat mental illness before stage IV should not be a goal that is considered unattainable; rather, it is a call to action for each of us to begin movement toward reducing barriers to care and enhancing lives.

“High Value Behavioral Healthcare” Speakers Answer Your Questions

Featuring a day jam-packed with engaging presentations and panels, the KHC 2019 Annual Conference was a success in highlighting the changes needed to help community members get access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

We packed a ton of great content into a small amount of time, so we didn’t get to all of the questions submitted by participants on our web application.

Let’s remedy that.

The KHC has spent the last couple of weeks following up with speakers on these questions, and we’ve compiled them below. Note that some answers have been edited for space.


“For Mental Health, Let’s Act Before Stage 4”

Paul Gionfriddo | President and CEO | Mental Health America

In other countries they have programs to integrate mental health treatment and the community. What do you think the barriers are to doing that in the US?

We tend to favor the system with which we have the most experience. In the United States, that has been characterized by separate and unequal care, first in state hospitals, now in jails and prisons, for people with mental illnesses. Our challenge is to change the way we think about mental health conditions, because thinking about them as public safety concerns (i.e. dangerous to self or others) makes it hard to fully integrate the services and treatment for them into the community.

How do we get people to seek treatment without the fear of retribution or ostracization?

First, we should screen everyone for mental health conditions as ubiquitously as we screen for blood pressure in adults, and hearing and vision in children. That’s what’s recommended for everyone over the age of 11 by the U.S. Preventive Services Task Force, but it’s just not done. By screening, we normalize mental health and mental health care and make this a part of overall health and health care. And then we can treat right away when it’s warranted, instead of letting up to ten years pass between the emergence of symptoms and getting the right diagnosis and treatment.


“Roadmap for Employers to Achieve High Value Behavioral Healthcare”

Mike Thompson | President and CEO | National Alliance of Healthcare Purchaser Coalitions

The National Alliance recommends ensuring health plans have network adequacy for behavioral health services. How is this best measured?

Most health plans have directory of network psychiatrists. However, few know whether those psychiatrists are taking new patients – ask them, by specialty if possible (eg child psychiatrists), what percentage of network behavioral health specialists are taking new patients.

Most health plans measure access to network providers by driving distance but few know or monitor how long it takes to schedule an appointment – ask them, by specialty if possible, what is the average wait time for an appointment for a new patient?

Most health plans will indicate that it is difficult to get behavioral health specialists to join networks but few have taken a positive step toward change this trend – ask them, by specialty if possible, how do network reimbursement rates for behavioral health specialists compare to non-behavioral health specialists? How do network reimbursement rates compare to out-of-network charges for behavioral health specialists? What is you plan to improve network participation rates of behavioral health specialist?

What do you think has shifted within our world society to now have this be recognized as a top 5 issues when it’s always been perceived as a personal and economic issue?

Three things that have contributed to Mental Health rising to be among the top issues facing companies and organizations globally:

1) growing recognition of the huge and disproportionate economic impact of the issue to companies and societies, well beyond the costs of treatment (e.g. impact on co-morbidity, impact on productivity. Impact on caregivers).

2) growing understanding of the physical and environment underpinning of behavioral health issues (genetics, social determinants and trauma, brain science) as well as how to prevent and treat it.

3) cultural change giving a growing voice to its wide prevalence and new acceptance as a human condition rather than a character flaw. This has been led by advocates, celebrities, businesses and policy makers.


“Unaddressed Drivers of Poor Mental Health (PANEL)”

Aja Barber | Community Health Administrator, Center for Health Equity | Louisville Metro Dept of Public Health

When is the next Health Equity Report slated to be released?

In keeping with the timeline so far, we’re anticipating releasing a 2020 or 2021 Health Equity Report.

From the CHE perspective, what can be done on a policy level to help close mental health disparities throughout our community?

We’re currently in process of building the legislative agenda for Public Health & Wellness so I don’t have a specific answer to this yet. But I do believe policies ensuring physical and mental healthcare as a guaranteed right for every individual are critical first steps.

Danesh Mazloomdoost, MD | Founder | Wellward Regenerative Medicine

What can we do as community members, professionals, and advocates for change to get the appropriate word out about the model that Wellward works off of?

Wellward looks for opportunities to work with the community and educating both patients and clinicians on this paradigm shift in addressing painful conditions. Any opportunity to speak or inform the public about Fifty Shades of Pain would be welcomed. While the book became an international bestseller, any purchase or review helps boost its visibility to the public, even a $0.99 Kindle purchase does a lot. Our goal is to simply create greater awareness about sustainable ways to think about pain in improved the health of our community such that pain problems become less prevalent. Your assistance in spreading that message in any capacity is helpful.


“Incenting Recovery Rather than Relapse through Bundled Payments (PANEL)”

Kelly Clark, MD | Founder, Addiction Crisis Solutions | President, American Society of Addiction Medicine

David Smith | Founder| Third Horizon Strategies

In a bundled payment model for medications treatment for Opioid Use Disorder, what non medicine therapies should be included?

Clark: In the PCOAT payment model, medications themselves are not core services/products being delivered.  The core elements to be covered are those consistent with the ASAM Guidelines for Use of Medications in the Treatment of Addiction Involving Opioids: Medical services for diagnosis, treatment planning and medication management; core psychosocial interventions including the levels of counselling which can be done by the prescriber with sufficient time and expertise; and care coordination activities.  There are different approaches in this bundle, depending on the capacity and capabilities of the provider/provider group.  More information can be found here.

Smith: We would be deferential to the professionals empaneled to provide care for the patient. The entire ARMH-APM turns on the axis of a treatment and recovery plan that addresses a range of mental and social considerations (in addition to clinical) that support a patient’s recovery. The clinical professionals and support teams that work with the patients are required to work with the patient in identifying specific therapies, in addition to addressing exogenous determinants that would interfere with the recovery plan and facilitate resources accordingly. The concept APM does set general guidelines regarding the need for evidence-based approaches to therapies holistically, but we also believe that the payment mechanism and the associated risk will play a role in motivating the underlying delivery system to provide non-medical services and therapies in a way that will sustain impact.

How do we move to a model that values quality care and implements metrics around performance?

Clark: We start by defining quality and performance. We can use the Triple Aim concept of Value = Quality/Cost, but quality of care in medical systems is an ever-expanding construct…Beginning by ensuring baseline process measures are used to ensure standards of care are being met – we don’t want to incent performance of cost savings by allowing care considered not to meet baseline standard of care quality metrics…Next, we need to consider the goals of managing chronic diseases: Decreased disease related morbidity, early mortality, total cost of care, and increased functioning/quality of life…To be operationalized, “Quality” is a very granular concept, and we must move boldly ahead to save lives.

Smith: It’s a collaborative enterprise and requires a payer to lean into a payment model that provides adequate resources for care that has a long-term orientation and supports the delivery system in its integration for the purpose of a more seamless patient experience. Our approach is to facilitate this through a risk-bearing provider entity capable of centrally managing a care team and the associated care transitions through a network of providers that engage the patient based on need and subsequently (or initially, depending on the patient) supports the patient’s assimilation back into their environment (or a new environment depending on the underlying circumstances).

Why don’t all clinics require counseling along with the administration of these medications? How is a patient supposed to differentiate between these clinics?

Clark: In an ideal world, people with any disease would have access to whatever interventions they need to help them manage their chronic disease at the time they need it, and also have access to things which would possibly benefit them. In the case of addiction, an individual at one point in time may require 24-hour care in addition to ongoing medication management, or require intensive outpatient care at another point in time, or require no further outpatient services than meetings with their prescriber. There is no one size fits all… 

We do not expect people with brain or other diseases to “talk their way out of their illness.” The currently available data we have for opioid addiction does not show improved outcomes by adding 60-minute formal counselling sessions to the regular physician medication management visits (which include supportive counselling and other techniques)…And forcing people into higher than needed levels of care does not improve outcomes – I have seen it simply discourage them from receiving the care they do need. Finally, there are structural and payment barriers to providing psychotherapy (done by licensed masters level professionals) in the same offices as prescribers which include licensing and payment issues as well as a shortage of either psychotherapists or counselors of lower educational requirements.

Patients and their families currently have few ways to determine the quality of care being provided by any provider or program. The ASAM/CARF certification, as well as the proposed Shatterproof rating system, are looking to make information about programs more transparent by means of independent site surveys (ASAM/CARF) or provider/patient/payer data collection (Shatterproof).

Patients with opioid addiction and their families can look here for information:

http://eguideline.guidelinecentral.com/i/706017-asam-opioid-patient-piece/0?

https://store.samhsa.gov/product/Finding-Quality-Treatment-for-Substance-Use-Disorders/PEP18-TREATMENT-LOC

The Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants

Where are these programs being piloted?

Clark: The P-COAT model does not currently have formal piloting occurring, but it does delineate the types of bundled payment approaches which are already being provided in some communities by forward thinking health plans working with engaged providers. 

Smith: Like everything in health care, we are living under our potential. We don’t get the results we pay for and have developed a delivery system that receives enormous financial benefit when patients have a recovery disruption or cycle through recovery. Our perverse incentives prevent us from driving the type of alignment across this diffuse ecosystem of resources that does a tremendous disservice to patients and their families.

Are recovery models serving people equally across socio-economic levels, including the homeless?

Smith: Today, no, not generally (in my opinion). This is where we need to go. Most Americans can access some form of coverage (non-expansion states notwithstanding). Even for those Americans unable to access coverage, the financial burden of addiction on our entire emergency infrastructure creates an economic rationale for society to provide these services. If we build a delivery model that supports this and link patients under the auspices of their coverage/non-coverage considerations, an underlying economic calculus that isolates value for parties (government, society, payer, etc.) should be a catalyst for establishing the right access to services for patients.

KHC Continues Conversation Around Behavioral Health with Successful Annual Conference

At the KHC 2018 Annual Conference, “Connecting Mental and Physical Health,” our organization pledged to continue to focus on the what many would say is Kentucky’s most important healthcare priority – behavioral healthcare. In addition to the many projects and grants related to behavioral health that we’ve had in the last year, our KHC 2019 Annual Conference continued the conversation started in 2018, titled “High Value Behavioral Healthcare.”

Featuring a day jam-packed with engaging presentations and panels, the KHC 2019 Annual Conference was a success in highlighting the changes needed to help community members get access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

Details about the conference agenda and speakers can be found here, but some of the highlights included:

  • A motivating opening speech by Mental Health America President and CEO Paul Gionfriddo, which got a standing ovation – a first ever for the KHC Annual Conference. If you are unfamiliar with Gionfriddo’s story or work, take few minutes to read his essay for “Health Affairs.”
  • An employer roadmap for achieving high value behavioral healthcare, developed by the National Alliance of Healthcare Purchaser Coalitions, to ensure that organizations’ health plans drive high value care.
  • Panels on the unaddressed drivers and contributors of behavioral health and new bundled payments to incent addiction recovery. Stay tuned for follow-ups with more discussion from these panelists on our blog!
  • A story of successful implementation of behavioral telehealth medical services by the Kentucky Employees’ Health Plan, presented by Commissioner Jenny Goins.

New Strategies Improve Interaction, Engagement

A record 212 individuals attended this year’s conference, and 75 of those individuals attended the pre-conference reception the evening before the conference, where they were able to meet with other attendees, conference speakers, sponsors, and exhibitors. Although always a challenging endeavor because of people’s demanding schedules, there was an increase of more the 40% in attendance and more food had to be ordered to accommodate. A fantastic problem to have!

KHC 2019 Annual Conference attendees listen to a panel.

The KHC also implemented a new system of commenting and asking questions, through Slido.com, which allowed more questions to be asked more efficiently. Compared to the previous app that we had used, this got a lot more engagement. We were able to archive additional questions that weren’t addressed and followed up with our speakers on them – stay tuned for those answers, coming soon!

The comments received from participants were overall very positive and educational. We are reviewing the feedback now and will use it to guide our future conference planning.

KHC conference achieved directive and financial objectives

The KHC staff, Executive Committee, and members appreciate our community coming together for another outstanding conference examining how to create a high value behavioral healthcare system. The conference met attendee’s expectations and provided finances to further the work of the KHC. The success of the conference would not have been possible without the support of our sponsors and exhibitors. A huge thank you to our Gold sponsors Pacira Pharmaceutical and Artemis Health, who each presented a showcase. An immense thank you to our partner Norton Healthcare, who has been a Silver sponsor for the fifth year. We also want to thank our partners Kentucky Primary Care Association and LG&E-KU for being Bronze sponsors. This year many of our partners and community organizations sponsored tables, allowing many of their employees and associates to attend the conference. A big thank you to table sponsors Norton Healthcare, Baptist Health, CHI Saint Joseph Health Partners/Our Lady of Peace, Anthem, Novo Nordisk, Department of Behavioral Health, Developmental, and Intellectual Disabilities, Trager Institute, Blue and Co. CPA, Commonwealth of Kentucky Personnel Cabinet, and Louisville Society of Human Resource Management. A pre-conference reception allowed attendees, exhibitors, and speakers to network. Thank you to Humana for sponsoring the reception. Finally, we want to say thank you to all of the exhibitors and attendees who participated in this year’s conference.

There is no rest when it comes to the KHC Annual Conference, so we’ve already begun planning the KHC 2020 Annual Conference, our sixth. Save the date for March 11, 2020, and stay tuned for the conference title!

KHC Fifth Annual Conference to Focus on High Value Behavioral Healthcare

On March 5, the KHC’s annual conference will move from a broad based view of value-based healthcare innovation to a deep dive into what many would say is Kentucky’s most important healthcare priority – behavioral healthcare. This conference will examine how employers, payers, and providers can ensure individuals have access to timely, appropriate mental health services and treatment, through the latest advancements in value-based behavioral healthcare.

Mental health and substance use disorder continues to rise to the top of many healthcare purchasers’ costliest and most prevalent conditions. Yet, these conditions are not treated by plans and providers the same way as physical health conditions. In fact, mental health is the only chronic disease in America that is not treated until Stage IV. And individuals facing substance use disorder continue to receive treatment that does not comply with current medical recommendations. Research consistently demonstrates smaller payments to behavioral health providers and higher out-of-network use for patients with mental health and substance use disorders, despite parity being law. All of these barriers create a system that often does not meet individuals’ behavioral healthcare needs.

The night before the conference a networking reception will be held, during which a short role-playing exercise by local high school students and a psychologist will demonstrate to attendees how adults and students can have positive mental health dialogue. Appetizers and drinks will be served, and exhibitors will be available.

The morning of the annual conference will kick off with Paul Gionfriddo, President and CEO of Mental Health America. Gionfriddo will provide an overview of mental health status and access in the United States, with a personal reflection on how, through policy decisions, he helped create a flawed mental health system that has failed millions, including his son.

Dr. Stephen O’Connor, University of Louisville Department of Psychiatry and Behavioral Sciences, will moderate four panelists, who will discuss several drivers and contributors to poor mental health often overlooked:

  • Dr. Joseph Bargione, a school psychologist, will discuss how healthcare networks can address adverse childhood experiences (ACEs) in patients
  • Dr. Danesh Mazloomost, anesthesiologist and pain management specialist, will discuss a new framework for treating pain that avoids addiction and has better outcomes
  • Aja Barber from Louisville Metro’s Center for Health Equity will explain how the relationship between mental health, social determinants of health, and institutionalized systems of power/oppression keep us from experiencing the kind of world we all deserve
  • Allison Tu, StAMINA and student at duPont Manual High School, will share youth insights into the factors influencing mental health from a series of focus groups conducted with high schoolers across Kentucky

Mike Thompson, President and CEO of the National Alliance of Healthcare Purchaser Coalitions, will discuss the roadmap and checklist his organization developed for employers to use in designing high value behavioral healthcare. All attendees will receive a copy of the roadmap, which includes an assessment of current performance of health plans and behavioral health organizations across key areas. The KHC is a member of the National Alliance, which represents more than 50 business coalitions in the U.S., supporting more than 12,000 healthcare purchasers and 45 million Americans.

A light continues to shine on the fact that many patients do not get appropriate treatment for substance use disorder. As a result, two new payment models have been designed to help incent effective treatment and recovery. Dr. Kelly Clark, an addiction psychiatrist and the President of the American Society of Addiction Medicine, will present the new Patient-Centered Opioid Addiction Treatment (P-COAT). The model is designed to increase the utilization of office-based treatment of opioid use disorder by providing adequate financial support to successfully treat patients and broaden the coordinated delivery of medical, psychological, and social support services. David Smith from Third Horizon Strategies will then discuss the new Addiction Recovery Medical Home (ARMH) receiving significant national attention. The model establishes a continuum of care from the time a patient enters an acute-care setting and is diagnosed with a substance use disorder through their recovery process. ARMH incorporates quality payments and bonuses for achieving certain outcomes and cost savings.

Telehealth has quickly gained the attention of employers and payers working to increase network adequacy of medical and behavioral health providers. Commissioner Jenny Goins will present examples of how Kentucky’s Department of Employee Insurance has implemented telehealth behavioral health along with the data related to utilization and financial savings.

Dr. Diana Han, Global Medical Director for Louisville-based GE Appliances, a Haier company will explore the reactions of local health plans to the day’s presentations. She will discuss with plans how their organizations are innovating to help individuals gain access to timely, effective, and affordable behavioral healthcare. Eric Bailly from Anthem and Dr. Stephen Houghland from Passport Health Plan will discuss their latest strategies to address network adequacy of high quality behavioral health services to their members.

Several other behavioral health innovations will be highlighted at the conference as well. Attendees will learn about a new non-opioid alternative for reducing opioid exposure post-surgery. A new MOMS Partnership that makes mental health within reach of over-burdened, under-resourced mothers will be presented. The KHC will will share the six priority behavioral healthcare measures selected to align Kentucky’s primary care providers and will provide a sneak peek into the soon-to-be released toolkit for employers on benefit design and workplace policies for supporting prevention, treatment, and recovery.

The conference will provide excellent networking opportunities for all types of healthcare stakeholders. Over 20 exhibitors will be available to discuss their latest products and services. If you have any questions about the conference, be sure to call the KHC office at 502-238-3603 or email info@khcollaborative.org. We hope to see you there next month!

SBIRT: Why Should I Care?

(Note: this guest post was written by Mallori De-Salle, Outreach Coordinator and Lead SBIRT Trainer, Indiana Prevention Resource Center)

I hate thinking about what I’m not doing ‘right’ when it comes to my health. I eat pizza. I’m not overweight, so it must not be a problem. I add salt to my food (without tasting it). I don’t have high blood pressure, so it must not a problem. I drink coffee in the morning, mid-day, and sometimes in the evening. I still sleep, so it must not a problem. This is my logic when deciding if I have to make a change. If it isn’t a problem, I don’t think about the health behavior at all. So, why should I care about how much alcohol I drink, if it’s not a problem?

Does this sound familiar? It’s not a problem, so why even think about it? Is the lack of highly problematic symptoms of an illness the only way to measure the existence or severity of a health problem? Or could we as an “illness focused” culture be missing an opportunity to focus on wellness instead of lack of illness?

For decades, our healthcare system has operated under the belief that “health” is defined through the absence of symptoms. In other words, concerns aren’t addressed or even considered a problem until the symptoms can be diagnosed. But, is it possible that problems exist on a wider spectrum? Is it possible that you or I could improve our health by reducing our risks even before problems are visible? Think about using a seat belt. Most of us wear seat belts automatically. It’s a habit (thank you public health) that we no longer think about. We wear seat belts, but not because it makes us better drivers or because we plan to crash. We wear seat belts as prevention because it lowers our risk IF we experience a situation where harm is possible. Not wearing a seat belt increases your “risk” for harm, even in minor vehicle incidents and most importantly, in severe circumstances. Wearing a seat belt doesn’t remove the risk of crashing; it reduces the risk of harm WHEN a crash occurs. Seat belts lower risk for a problem that doesn’t even exist yet.

Seat belts are fairly concrete (actually they are fabric, but you understand). However, other health behaviors, such as alcohol or substance use, can be more abstract. What if we look at alcohol or substance use as a health behavior that can either increase or decrease our risk for experiencing harm, much like our current views on seat belts? Public health is back again with a new preventive practice to do just that!

SBIRT, or Screening, Brief Intervention, and Referral to Treatment, is a public health approach which changes how we view alcohol use. Instead of simply looking for indications of diagnosable problems, it examines all levels of use and how use impacts all levels of wellness. This suggests that wellness can be enhanced by understanding that health is not simply the absence of illness. SBIRT asks all patients (even the little neighbor lady down the street) annually about their alcohol or substance use. Doing so helps increase the chances that a person considers how their level of use is influencing their quality of health. SBIRT is not a diagnostic process, but instead a conversation that helps support intrinsic motivation for behaviors that support wellness and not just the avoidance of illness (in this case, addiction). SBIRT, like all other new movements, viewpoints and culture shifts (remember how people hated seat belts at first?) takes time to feel comfortable. Once it is in place, everyone starts to think, “Why haven’t we been doing this?” So, buckle up! SBIRT is taking the driver’s seat and letting us know that improving our health, wellness, and happiness is why we should care.

For more information on SBIRT or to download KHC’s toolkit for primary care providers, click here

QPR Reflections: Suicide Prevention Training Hits Home

A couple of weeks ago, the Kentuckiana Health Collaborative held its September Community Health Forum. The topic was youth mental health, and the date coincided with National Suicide Prevention Week. After the Forum, the KHC hosted a Question, Persuade, Refer (QPR) training as part of a goal to set a record for people trained in one week. Similar to CPR, QPR is a 90-minute training course designed to support an emergency response to someone in crisis. It was designed to equip individuals with the tools they need when someone in their life is facing a suicide crisis.

I was in that position last year, trying to convince the person I loved most in the world not to take their own life. It’s an experience I don’t wish on my worst enemy. I’m at a year of therapy and counting, and although I am a much stronger person for the experience, I wish I had never been through it.

In the end, my loved one didn’t take their life, and they got the talk therapy and medication needed to push through. Multiple people have credited me with that outcome. I’m not sure if I agree with that, but I do admit that my involvement might have had a positive impact and recognize now the power that even one individual can have in moments of crisis.

Hence the need for trainings like QPR. Suicide is the 10th leading cause of death in the United States, and it’s estimated that for every death by suicide, there are 25 more attempts. It happens more commonly than we’d like to believe. During National Suicide Prevention Week, more than 2,200 people in Louisville were trained in suicide prevention in 50 locations across the city.

I’ll admit that I was slightly disappointed by the QPR training. I guess I thought that it would reveal one magic thing that I could have said or done differently, to make the situation turn out more smoothly than it did in my case. I was disappointed to find that there is no magic bullet to be had. People are complex. These situations are complex. There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

I don’t think I was prepared for the traumatic memories that QPR would bring up. Much of the 90-minute session was devoted to recognizing the signs and behaviors of distressed loved ones. I can say that from my personal experience, what was taught in QPR related to this was almost word-for-word what I experienced. I had to leave the room more than once in tears. But I always returned, determined to see it through. Then came the disappointing part of the training. The part where I discovered that there is no perfect phrase that can talk someone off the proverbial ledge. But that doesn’t mean that we can’t have an impact on the situation. We can all create safe spaces for our loved ones to talk to us when they are struggling, and we can together get through the tough times.

I had nightmares that evening about those past traumas. But then, a funny thing happened. The nightmares that I’d been accustomed to having for the last year stopped. Situations and places that used to trigger me no longer did. And I realized that it was a direct result of the QPR training. I had long ago forgiven myself for what I had seen as failings when I was faced with the crisis, but it turns out that I didn’t need to be forgiven at all. By participating in the training, I realized that I did probably more in that situation than I should have been able to. It wasn’t blind luck that prevented my loved one from taking their life. And that was the closure that I didn’t know that I needed.

It sounds like a cliché to say that you never think it will happen to you until it does. But that’s exactly how it is. And I would recommend that anyone learn how to have that conversation and develop that vocabulary, through QPR or a similar program. Because you never know when you might need those skills.

Students and Adults Work Together to Generate Ideas for Youth Mental Health at “Ideathon”

Prior to last Saturday’s StAMINA Youth Mental Health Ideathon, the concept of an “ideathon” was easy enough for me to imagine, much like a danceathon but just a whole day of generating ideas around supporting youth mental wellness. With this in mind, I didn’t expect the StAMINA Ideathon to be as engaging, organized, inspiring, and productive as it turned out to be. Even my teenage son, who does not typically spend his Saturdays hanging out with his mom, was completely engaged in the process, and we both left energized by the possibilities to make a positive impact on youth mental health.

StAMINA (Student Alliance for Mental Health Innovation and Action) discussed the findings of its new research on youth mental health at the KHC’s Community Health Forum on September 11, and the subsequent Ideathon, designed to generate ideas to address the findings of that research, was held on September 15. Amanda Tu, a Junior at Stanford and sister of StAMINA founder Allison Tu, led Ideathon participants through the design thinking process as defined by Standford’s d.school. The process for design thinking is comprised of five steps: empathize, define, ideate, prototype, and test. Since the empathizing and defining had already been completed through the research, the focus of the Ideathon was to “ideate” and begin to “prototype.”

Ideathon participants were led through the design thinking process as defined by Standford’s d.school.

There were about 50 people in attendance that were divided into several small teams of five to seven individuals. Participants included students, parents, grandparents, guidance counselors, mental health advocates, pediatricians, public health officials, and more. The groups were carefully divided into teams representing unique perspectives. Nearly half of the day was spent in our groups discussing solutions to the problems identified in the research, sorting the ideas, selecting the top idea, prototyping the idea, and, finally, pitching the idea to the group.

All seven teams generated detailed ideas and then presented their pitch and skits to all of the participants. The process was fun, and there was a lot of laughter and energy during the skits. The top three ideas selected included a student-led podcast on mental health, an app with mental health resources, and dinner card conversation starters for parents and students. The StAMINA and KHC teams will now analyze which ideas are feasible with current resources to be advanced in our community.

The winning team’s idea included a podcast that addresses youth mental health issues.

Tamlin Hall filmed the entire StAMINA event, conducted one-on-one interviews, and will be putting together a video of the event. Tamlin is an award winning filmmaker, whose movie “Holden On” tells the true story of his childhood friend, Holden Layfield, who struggled with mental illness as a teenager.

StAMINA’s three-prong approach is now moving from the learn and build phase to action. Allison Tu, founder of StAMINA, often explains to adults that it is the students that are experiencing their own mental health, and it only makes sense that they are the ones to help find the solutions. It’s clear from this work that she is right that a student led approach will realize the best results; it’s already happening.

See StAMINA founder Allison Tu talk about her group and Ideathon on WHAS.

 

PRESS RELEASE: High School students examine mental health stigma in KY teens


Findings: Adult, peer views on mental health contribute to stigma

Press Release by Hayley Kappes, University of Louisville

LOUISVILLE, KY September 6, 2018 – Parents who refuse to take their children to therapy because they don’t believe in mental health treatment. School counselors who have told students to stop crying because they’re “fine.” Teens further ashamed of mental illness because of negative portrayals in the media. These are some of the experiences that a high school student group, mentored by a University of Louisville clinical psychologist, has gathered from peers across Kentucky during yearlong research into factors that contribute to mental health stigma in teens.

Allison Tu

Allison Tu, a senior at duPont Manual High School who led the student group, and Stephen O’Connor, PhD, associate director of the UofL Depression Center who guided the students in research, will present findings during the Kentuckiana Health Collaborative Community Forum on Tuesday, Sept. 11, from 8 to 10 a.m. at the UofL Clinical and Translational Research Building, 505 S. Hancock St. After the forum, a Question. Persuade. Refer. (QPR) Suicide Prevention Training by the Louisville Health Advisory Board will take place.

The student group, comprised of teens across the state, is called the Student Alliance for Mental Health Innovation and Action (StAMINA) and is supported by the Kentuckiana Health Collaborative, a nonprofit organization that aims to improve health and the health care delivery system in greater Louisville and Kentucky.

StAMINA conducted a needs assessment of the state and held focus groups in urban and rural areas with high school students and parents to uncover what interferes with students acknowledging they have mental health issues and receiving treatment. The group also interviewed mental health professionals and pediatricians.

Factors that contributed to mental health stigma among high school students included negative representation of mental health in media and stigma from peers and parents who do not have a positive attitude about mental health, Tu said. The group found differences between rural and urban residents.

“Because there is more racial and ethnic diversity in urban settings, one of the big drivers of mental health stigma is ethnic heritage,” Tu said. “African-American and Asian-American students talked a lot about how culturally, mental health was often ignored. With rural students, generally there was more stigma resulting from religious factors. Some students said they would talk to their parents about mental health issues, and their parents would respond, ‘you’re not praying enough.’”

Stephen O’Connor, PhD

Messages that parents express about mental health impact a child’s views, said O’Connor, who guided the research design, and taught the students how to lead focus groups and conduct qualitative data analysis.

“The gatekeeper for getting children to treatment is often going to be a parent, so parental views on mental health are likely going to impact whether a child is taken to treatment,” O’Connor said. “The parent also is helping the child understand what they’re experiencing, so if the parent doesn’t have a good idea about what symptoms of mental illness represent, then the child is probably not going to understand either.”

Solutions to mental health stigma among teens may include a new mental health education requirement for high school freshmen or a social media campaign to amplify the visibility of resources, said Tu, who also stressed the need for parents to be educated on mental health issues and resources available for their children.

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SBIRT Toolkit Released for Healthcare Providers to Address Opioid Crisis

In recent years, the misuse, addiction, and overdose of opioids has grown to epidemic levels at the national, state, and local levels. Kentucky is no exception, with its opioid epidemic ranking among the worst in the nation. As of 2016, Kentucky ranked fifth among states with the highest number of drug overdose related deaths. With 33.5 deaths occurring per 100,00 people, the state experienced a 142% increase from 2010.

Significant action has been taken by a multitude of stakeholders in response to this epidemic. A prominent force has been the work completed as part of the Kentucky Opioid Response Effort (KORE). KORE is part of the Opioid State Targeted Response (STR) grants, created by the 21st Century Cures Act and administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of KORE is to implement a comprehensive targeted response to Kentucky’s opioid crisis by expanding access to a full continuum of high quality, evidence-based opioid prevention, treatment, recovery, and harm reduction services and supports in high-risk geographic regions of the state. Earlier this year, the Kentuckiana Health Collaborative (KHC) began a project in partnership with KORE to increase awareness and utilization of Screening, Brief Intervention, and Referral to Treatment (SBIRT) among primary care providers as a means of addressing unhealthy substance use among their patient populations.

SBIRT is public health approach to identifying and intervening with patients who are participating in risky substance use behaviors. As a system change initiative, SBIRT challenges traditional approaches to identifying and intervening with Substance Use Disorder (SUD) by viewing behaviors, problems, and interventions on a continuum. SBIRT focuses on reaching the 15%-25% of the population who are excessively using substances, while still intervening with the 5% needing traditional treatment and positively reinforcing behaviors of the 75%-85% who are abstinent/responsibly using. The bulk of health, social, and economic costs associated with substance use are associated with excessive use rather than addiction or substance use disorders. By addressing the population excessively using, primary care providers can negate the negative effects of these costs and prevent the progression of substance use behaviors. There is substantial evidence for the use of SBIRT in reducing risky behaviors related to alcohol, and its application for opioid use is accumulating and promising.

The KHC has developed a toolkit, titled “Screening Brief Intervention, and Referral to Treatment (SBIRT) – Addressing Unhealthy Substance Use in Primary Care Settings” that is being distributed to over 4,000 primary care providers and 400 group practice managers throughout the state of Kentucky. The KHC will also be holding a complementary webinar on Wednesday, October 10, 2018. Webinar registration and additional information can be found here.

SBIRT is a practical and promising approach to addressing the growing opioid epidemic in Kentucky. Join us in learning more about this initiative and encouraging its adoption throughout the Commonwealth.

View Toolkit

Louisville’s Multi-year Focus on Suicide Prevention Ramps up to Set a World Record, Save Lives

(Note: This guest post was written by London Saunders Roth, Local Integration Leader, Louisville Bold Goal, Humana. London is a member of the Louisville Health Advisory Board Behavioral Health committee.) 

A community-wide coalition focused on suicide prevention is organizing a broad-based community effort centered around National Suicide Prevention Week: September 9-15, 2018. The Louisville Health Advisory Board (LHAB) Behavioral Health committee seeks to help Louisville set a world record by training the most individuals in one week in the technique of Question, Persuade, Refer (QPR). Similar to CPR, QPR is a 90-minute training course designed to support an emergency response to someone in crisis, and it can save lives.

According to recently published data from the Centers for Disease Control and Prevention (CDC), suicide rates are on the increase, and more than half of people who died by suicide did not have a known mental health condition. For the years 2008-2014, Jefferson County ranked 11th out of 50 peer counties in terms of highest rates of suicide. This is a change from the prior ranking of 8th; however, the suicide mortality rates were higher nationally. Essentially, while other counties increased at a higher level, Louisville’s suicide mortality rate still increased. These statistics are what inspired a cross-sector of community partners to come together and set an objective to design and implement a community-wide, evidence-based and data-driven program to eliminate suicides in Louisville.

Many people are uncomfortable discussing suicide, even when family or friends may be in crisis. However, the technique of “Question, Persuade, Refer” (QPR; www.qprinstitute.com) can improve a person’s comfort and confidence in broaching this difficult subject. QPR is an intervention that can improve the “Chain of Survival,” similar to CPR’s impact on increasing public’s confidence to provide life-saving interventions. QPR focuses on three things: how to recognize warning signs of suicide, how to offer hope, and how to refer to resources to help to save a life. Early recognition of suicide warning signs is key to saving a life.

Please join Louisville, and the Louisville Health Advisory Board, in saving lives this September. If you are interested in getting involved in this effort to increase public awareness and the community’s skills in suicide prevention, please visit www.qprlou.com to sign up for a FREE training or email LouisvilleZeroSuicide@gmail.com with questions.

Additionally, LHAB and Kentuckiana Health Collaborative will offer QPR training immediately following the KHC Community Health Forum on September 11, which will examine findings of new, rigorous qualitative research that evaluated unique youth perspectives on mental health, as well as those of adult allies. You can register for the complimentary Community Health Forum here. Space is limited for the following QPR training session. If you would like to join in on this life-saving training, click here.

Please remember that there are resources for you, family, and friends related to suicide prevention. The national suicide prevention hotline is 1-800-273-8255 and a local (Louisville) crisis line number at Centerstone (formerly Seven Counties) is 502-589-4313.

The Louisville Health Advisory Board is a cross-sector group of community organizations and leaders working to improve physical, mental and social well-being where residents of Kentuckiana live, work, worship, learn and play. The Behavioral Health committee is a part of this board, and its mission is to design and implement a community-wide, evidence-based and data-driven program to eliminate suicides in Louisville.