Please join us for a virtual Expert Panel, from November 18 to 22, to share experience and discuss possible solutions to improving mental health services and the potential for integration into primary care.
One in four adults −approximately 61.5 million Americans− experiences mental illness in a given year. One in 17 −about 13.6 million− live with a serious mental illness such as schizophrenia, major depression or bipolar disorder. (The National Alliance on Mental Illness. March 2013. http://www.nami.org/factsheets/mentalillness_factsheet.pdf) Globally, people with mental disorders experience disproportionately higher rates of disability and mortality. Homelessness and inappropriate incarceration are far more common for people with mental disorders than for the general population, and exacerbate their marginalization and vulnerability. (World Health Organization. 2013. http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf)
Between 76% and 85% of people with severe mental disorders receive no treatment for their disorder in low-income and middle-income countries, the corresponding range for high-income countries is also high: between 35% and 50%. (WHO. 2013) In the U.S., treatment of mental illnesses has gone from an inpatient model of mental hospitals, as portrayed in the novel, and later film One Flew Over the Cuckoo's Nest, to an outpatient and community-based model. However, the US has not yet succeeded in developing an integrated community-based mental health care system reliably accessible to those in need of services. In poor and developing countries, the WHO states, mental health is completely neglected and the quality of care is poor with very few mental health professionals. There, the WHO argues, redirecting funding for mental health towards community-based services would allow access to better and more cost-effective interventions for more people.
Today, some are calling for a new model that would integrate mental health into primary care. The idea is that receiving care in an integrated model, as opposed to having to visit separate facilities and various clinicians, would be more beneficial to patients and their health. While this approach seems to achieve positive outcomes overall, the literature is less clear on benefits and identifies numerous challenges. In its 2008 evidence report on the subject, The Agency for Healthcare Research and Quality concluded that “without evidence for a clearly superior model, there is legitimate reason to worry about premature orthodoxy.” (AHRQ. October 2008. Report No.: 09-E003. http://www.ncbi.nlm.nih.gov/books/NBK38632/) But in a 2012 report, AHRQ notes that “Collaborative care interventions improved outcomes for depression and quality of life in primary care patients with multiple different medical conditions.” (AHRQ. August 2012. Report No.: 12-EHC106-EF. http://www.ncbi.nlm.nih.gov/books/NBK100652/)
We are delighted to welcome the following panelists:
- Ken Duckworth, MD, serves as the medical director for The National Alliance on Mental Illness (NAMI). He is double board certified in adult and child and adolescent psychiatry. Dr. Duckworth is an Assistant Clinical Professor at Harvard Medical School, and has served as a board member of the American Association of Community Psychiatrists.
- Allison Hamblin is Vice President at the Center for Health Care Strategies. There, she focuses on system-level strategies to promote integration of physical and behavioral health services in primary care and other settings, particularly for low-income populations.
- Giuseppe Raviola, MD MPH, is medical director of the Psychiatry Quality Program at Boston Children's Hospital, an Assistant Professor of Psychiatry and of Global Health and Social Medicine at Harvard Medical School, and is involved in a variety of mental health work in rural communities here and in abroad. He notably leads the Dr. Mario Pagenel Fellowship in Global Mental Health Delivery with mental health clinicians in Rwanda, Haiti, and in the U.S.
- Stephanie Smith, MD is a psychiatrist at the Brigham and Women’s Hospital in Boston where she is a fellow in psychosomatic medicine. She is also a fellow in global mental health delivery and implementation science in the Department of Global Health and Social Medicine at Harvard Medical School. Since 2010 she has worked in Rwanda with Partners In Health.
- Anjali Thakkar is the Co-Director of Behavioral Health at the Crimson Care Collaborative Chelsea in Boston. She has been implementing a program called IMPACT which incorporates mental health into primary care visits. She also has worked with the Institute for Healthcare Improvement on developing a tool for behavioral health organizations to assess their ability to integrate primary care services.
During our virtual Expert Panel discussion, we will address the following questions:
Day 1. What are today’s main challenges and promises to providing mental health services to people affected by mental health diseases in your setting?
Day 2. What models of integration have been used? What are the key elements of programs and payment schemes that have been implemented and sustained in large health systems but also in resource-limited settings?
Day 3. What barriers have you encountered in integration of services? How can we address these?
Day 4. What is the role of peer supporters, social workers, and patients in improving mental health services and integration? Are there any Health IT applications that show promise for self-support?
Day 5. In conclusion, how can we improve the delivery of mental health services for patients and their families? What is the role of research, policy, and advocacy?
How to Participate:
1. NCD and YP-Chronic community members: This Expert Panel is taking place in both communities. You will receive email notifications for this panel based on the email notification settings you’ve selected for these communities in your GHDonline profile. If you’d like to update your email notification settings for this Expert Panel, or any of your GHDonline communities, please log into your GHDonline account (https://www.ghdonline.org/accounts/signin/) and select « Edit Email Settings » from the « My Profile » drop down.
2. Not a member of GHDonline? Click the « Join Expert Panel » button on the right to sign up for this Expert Panel.
This panel is part of our US Communities Initiative, which is supported by the Agency for Healthcare Research and Quality (AHRQ), and aims to foster discussions between health care professionals on evidence-based practices, and translating these practices across disparate settings, to improve health care delivery in underserved populations in the US.
Finally, in an effort to understand the impact of our Expert Panels and how we can improve, we invite you to take a short 4-question survey before this panel begins at this link: https://www.surveymonkey.com/s/8V33NBL. Once the panel has concluded, we will invite everyone to answer a similar, short follow-up survey.
We look forward to this discussion, so join the conversation and share your thoughts!