Making Mental Health Care Accessible and Responsive: a call to action.

At my agency, Family and Children's Service of the Capital Region, we are currently re-designing our services to provide more accessibility for our EAP and other clinical counseling clients.  

Only 36% of people living with a mental health disorder receive treatment for that disorder (National Institute of Mental Health). We know that this statistic rings true for our local region and our EAP members as well. In general, people suffering from a mental health disorder do not reach out for help, or they wait until it gets really bad to reach out.  

So, how does an agency try to bend this trend and increase the utilization of mental health services, truly serving more people in need?

At our agency, phasing it in this year, we will start to try to "bend this trend," by providing telephone, chat and email service.  This service will be more immediate and easier to access. Clients will no longer access service by calling us and and then waiting for a scheduled face-to-face appointment a week later.  Calls will be answered by counselors and they will be provided service immediately if they need it. 

If they want to call us about their issue and receive support on the phone for 20 min, they will get it.  If they want to chat to us from work on their lunch break about the anxiety they are having at work, they will be able to do it.  If they want to email us to simply ask for resources on parenting, they can do that too.  In all cases we will provide them with the service they ask for, however they choose to ask for it, and when they want it.   We will be tracking our utilization and hope to see it go up drastically, as we know that by using the old school in-person counseling model exclusively, we are missing the majority of the people that need help.

The consumer of today needs and in fact demands much more.  Everything else we consume is offered how and where we want it.  Pizza at our doorsteps, groceries and clothes in one big box store, books and movies on-demand online.  The mental health consumer of today wants service in the same way.

It's up to us, mental health administrators and managers, to figure out how to provide high quality, clinically appropriate care in multiple ways. Waiting and insisting that clients come to us for care is not only unrealistic, but irresponsible. Face-to-face counseling will always be needed and in fact, is preferable, but we need to figure out better ways to engage MORE people, to engage them at lower level, less intense service levels as well. Otherwise, we will continue to miss the 64% of people that live with a mental health disorder every year but never access care.

Let’s start thinking bravely and figure out what makes mental health care accessible and responsive.  Next, let’s not get hung up on, “but I don’t know how to do that (ie social media, online, apps, texting, email service),” and instead find someone who does know how to do it (there are many of them) or take an online course at the TeleMentalHealth Institute to educate yourself on how to make the needed adjustments.

Not only will you be better fulfilling your mission to serve, but in the end, you will have more business and better business. 

photo credit: ~C4Chaos via photopin cc

First Nation’s People of Canada are not Victims, but Realists.

It’s easy to come to the conclusion that the First Nation’s people who are currently protesting across Canada, and in Ottawa, are playing the “victim” card.  But this is a shortsighted statement.  For the many non-native, white, or other ethnic Canadians, it is hard to understand the historical traumas and disruptions suffered by First Nation’s communities, families and individuals.  I don’t think the First Nation’s people’s are saying, “do this for us”, or “we want you to give us this.”  Instead, I believe they are looking for a dialogue with the powers that be, and most importantly they are searching for a new path forward for their communities. 

They understand acutely that in order to contend with a government of a prosperous nation, heavily influenced and controlled by multinational corporations that badly want access to their lands and resources (and want access to those lands to be sold to them by First Nation’s people who are poor and hungry for cash), they need to start an organizing process with a big splash that includes protests, hunger strikes, and blockades.  Native peoples around the world understand that without the money that serves to influence government and people in conventionally accepted ways like lobbying, advertising campaigns, and online webpages so slick and “green” you would think they were from the people trying to save the environment (not destroy it), they will be no match to the powers that be.  Big organizing against big power has to start this way.  

It is now up to us non-native, white and other ethnic peoples of North America to be supportive and helpful to them. They do not need anger or dismissive attitudes.

Sometimes the complexity of the issue can force negative reactions from those who do not wish to look further at the details. As sited it the manifesto at the Idle No More website, they are standing up for,  "outstanding land claims, lack of resources and unequal funding for services such as education and housing.”  Each of these statements are complex and can be backed up by thousands of pages of reports.  What stands at the end of all these reports is the striking truth that First Nation’s communities are not doing well.  As Chelsea Vowel states clearly in her article, the First Nation’s people are dying because of these inequities, and then expressly does not apologize for being sensational, because it’s true.

Having come back from a First Nation’s conference on preventing suicide in Montreal just last month, I certainly do not need any more reinforcement in understanding this.  First Nation youth are dying of suicide at rates 10-20x higher than other comparable youth groups.  If your sons, daughters, nieces and nephews were dying of a completely preventable mental health disorder, and you realized that lack of access to healthcare in your community was contributing to this, would you be angry?  Would you do something about this?  I hope so.

So, it is up to us, the non-First Nations people of Canada, North America and the world, to be supportive and helpful to the First Nation’s people now, not negative.  They have embarked on a sacred journey that will be difficult but is necessary.  I offer them many blessings and much strength and an intelligent spirit of determination.  And I hope that my gifts as well as the gifts of many others may serve to assist them on their journey. 

photo credit: Caelie_Frampton via photopin cc

How the "Most Perfect" of the Health Homes will use Technology

In my last blog submission, I promised I would explain how the "perfect" health home, the one with the best outcomes, will disrupt conventional health care systems (and thinkers) and use as many telehealth tools as possible.

An information universe

So what does this mean?

I will break this down into two areas:  medical information sharing, and service provision.  The smart thinkers designing health homes have already figured out the first one (well most of it!), but the second area (service provision) will need to be designed by the service providers and local health home leaders - and in my opinion will be the one factor that sets apart the success of one health home, vs the relative mediocrity or failure of another.

1. Medical Information Sharing
One way health homes will use technology differently from the case management systems they are replacing is by utilizing a medical information technology sharing platform.  This regional platform in my region of New York State (Capital Region) will by administered by HIXNY and all of our regional health homes and downstream providers must document their cases and service in one of many software platforms that is compliant with HIXNY.  HIXNY will then grab data from these local platforms, and combine it with real time data from medical providers so that all medical information is accessible by the health home case manager at any point in time.  Furthermore, the case manager will be able to receive "alerts" when client, "Nancy," has entered the hospital.  The care coordinator will have medical information at hand, all the time.

Obviously this is transformative, and I believe in a very positive direction.

Challenges in implementing this approach are not only found in the mammoth task of ensuring platforms can speak to each other (the task at hand now), but also are found at the micro level with the care coordinators.  Now care coordinators need to be able to access this info all the time.  And how do they do this, what types of laptops, tablets or smart phone platforms should they use?  Questions of after-hours care also soon come into play:  who monitors this information 24/7, and who responds to an urgent situation emerging with a client on a Sunday morning, now that we know this situation is happening in real time?

2.  Service Provision

Essential tools of a Care Coordinator (and their clients!)

Next, with all this new information, how is the case manager supposed to respond to each piece of information?  Medication was changed by the doctor on Dec 1 but is still not filled two weeks later?  A family crisis causes homelessness and basic needs are suddenly a challenge threatening medical stability?

With an average of eighty clients each, the care managers will not only need to deal with these clients expediently and effectively (using telephone, email and text to coordinate with providers and the client) but also will need to have the information for helping at their fingertips (an online 2-1-1 database) and also be given clear policy and procedure by supervisors about how to manage  each situation.

Will enhanced Medical Information Sharing help provide better health outcomes for high-end utilizers of health care, YES!  Will health home administrators have to completely re-think what "case mangement" is, YES, and it will be no easy task.

But keeping in mind the core concept - the need for MORE connections - and how to maximize these connections between each medically vulnerable person and their care coordinator and medical providers - will be key to success.  If we think in traditional, face-to-face/appointment centered care, we will trip ourselves up.  Thinking about effective high-touch, low cost solutions will be the only road to success.

photo credit: GustavoG via photopin cc

photo credit: Yagan Kiely via photopin cc

Where is my Health Home? An intro to Health Homes in New York State

Health Homes will help people connect to care more often.

Today I visited St Peter's Hospital in Albany, NY, for the first meeting of the Capital Region Health Home, a new entity combining the Rennselaer County and Albany County Health Homes into one.  The meeting was excellently led by Rachel Handler, possessing the most skill ever demonstrated in the history of health care, in making dry Department of Health-speak interesting and accessible.  Health homes, to clarify, are not a place where anyone lives, rather a health service entity that will wrap services around people with severe physical and mental health issues, and most people in the health home will have both.

Health homes, to be excruciatingly brief, aim to lower costs of health care, while providing better health outcomes for its, "not so waiting room friendly," inhabitants.  According to the NYS Department of Health statistics, 18% of New York State's Medicaid population accounts for 50% of its costs.  They exist at the edge's of our society, costing our state and local governments (all of us taxpayers) a lot of money because they are chronically unwell.

These are people who are lonely, sad and sick.  These are people who need connections, but usually push away people who can help them or support them.  They are people that often have a hard time making and maintaining friendships, and whose family members are tired of them.  These are human beings that deserve to feel and be well, but do not and have not for most of their lives.

So how do they access health care?  By going to the emergency room fifty-nine times in one year (yes this is an actual case example).  By not going to their dentist until their mouth is infected.  By calling their primary care provider so many times that they are asked to find another doctor.

These are people that need more and not less connections and so are perfect for a health care system that uses technology to provide them with MORE connections, when and how they need it.  Stay tuned for my next post on how the "perfect" health home, the one with the best outcomes, will disrupt conventional health care systems (and thinkers) and use as many telehealth tools as possible.

photo credit: Lars Plougmann via photopin cc

Dedication to a young First Nations Woman: we can do better.

To open this blog, I would like to share a short story from the Canadian Association for Suicide Prevention Conference, held in Niagara Falls, Ontario in October. 

Usually conferences are opened by government dignitaries or experts and researchers, so I was pleasantly surprised to see the first speaker of the day assume the stage:  a petite First Nation's woman who spoke with gravity.  Her name was Elaine Johnston and she was the director of a First Nations community health center in northern Ontario (http://www.mnaamodzawin.com) 

I had heard of "suicide problems" in the First Nation communities of Canada, but didn't quite understand that it was one with sorrows possibly deeper than in any other community on our earth.  One young man I spoke to shared that he had lost two sisters to suicide.  A woman from a community of 1,250 people in a remote area of northern Quebec told me that her community had suffered seven teenage suicide deaths in 2012.  Sorrow, loss, and trauma hardly express the situation here.  Coping?  How can they when they can only be scared of who is next. 

On this day in October, Elaine assumed the stage and shared that when her niece had died from suicide, Elaine asked her grandmothers for guidance in a dream.  The dream came and the grandmothers told her that the spirit of suicide was both dark and light.  The dark spirit of suicide is the spirit of grief, depression and hopelessness.  They advised her that this spirit was walking rampant throughout her community but must be contained.  They told her that giving it a place at her table, an empty chair, would give it a place to stay so it wouldn't walk freely throughout her community.

But the grandmothers also told her that suicide has a light spirit, the side that teaches those left behind what it means to be human.  An example of this light body was the the good work of people to organize this conference dedicating to preventing suicide. Another example was the work her sister did after her niece died, to educate and support the young people in her community.  

Her story touched me and has inspired me to learn from what has gone wrong, to do better for the young people of the future, to learn all that I can from the light spirit side of suicide.  

This blog is dedicated to the memory of this young First Nation's woman, and all the other young people who have lost their lives because the society they grew up in did not give them the support, the knowledge, the direction or the compassion needed to move them through their most difficult moment. 

We can do better.  There are tools at our fingertips that can help us reach people in distress like we have never done before.  It is not time to naysay or to be fearful of technology and what it can do to reach those who need help.  The stakes are too high. 

photo credit: Trevor Dennis via photopin cc