QUALITY: Mental health–any ideas?

I was highly struck by something Dr David Sobel said in his great speech at the Ix Therapy conference last October—he suggested some 50% of primary care office visits are the result of background mental health issues. That sounds intuitively right. After all a British GP once told me that his most frequent symptom was “TATT” (tired all the time”).

Meanwhile I’ve been getting to know a homeless childrens’ organization in San Francisco, which specializes in mental health services for those families. And not surprisingly those kids have issues that result in wide social and health problems later on (but not too much later on) in life.

Then today a reader asked me if there was any evidence on whether more care overall, and specifically more specialty care, would help those with mental illnesses? And whether providing more treatment manages to save money down the line (presumably in other areas).

Mental health has not been an area we spend much time on at THCB, other than perhaps to acknowledge that we over-medicate some populations. But Vic Fuchs did say to me once, “remember, the head is connected to the body”.

So does anyone have any data or conclusions about whether specialty mental health care is a) effective and b) a good investment? Please comment below.

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10 replies »

  1. Managing mental health is a big problem; there is only less way available to manage it. Particularly, affecting children mentally is seems to be a big problem
    Drug Alcohol Rehab
    Drug Alcohol Rehab

  2. The most prescribed class of medications in this country is antidepressants, so it comes as no suprise that doctors of multiple specialties likely are utilizing these meds for thier patients.

  3. Even as a layman I can say it’s absurd to suggest mental health treatment be ignored or even that it’s less important than physical health treatment. The two work together.
    The good news is that tools to measure outcomes are exploding right now. This revolution is taking place within treatment facilities, and treatment professionals are designing the workflows and content.
    HIPAA and 42CFR seem pretty effective in ensuring privacy in this industry, and we’re even learning how to live within these dictates with consumer portals to their own mental health and public health information. The current breakthrough involves electronic sharing of referrals, discharge summaries, medication lists and other information in an interoperable environment. Secure, authorized sharing of patient treatment data among unrelated agencies.
    Exciting times.
    The challenge has been to bend the IT solutions to fit MH and SA treatment documentation requirements. With the acceptance of the concept of treatment plan “best practice” content, “yes/no” and “multiple choice” answers for assessments, and notes that relate directly to many other areas of the chart, coding has evolved into flexible standards that address and relate both the DSM IV and ICD 9 worlds. Narrative is required, but not the exclusive solution to documentation of treatment.
    Aside from the published facts presented in this string, we can all offer some personal examples of mild symptoms that relate physical and mental health issues. Recently I have had trouble catching my breath due to inhaling some fumes from an industrial strength cleaner…surely, we can all imagine the anxiety that results from not being able to breathe normally. In this case, some meditative techniques and a solid dose of albuterol relived all symptoms. That’s a combined physical health and mental health solution that can be expanded upon to treat clinically ill patients.
    If you’re looking for somebody who might have good ideas about revamping funding for mental health treatment at least in the Medicaid environment, try googling Dr Ron Manderscheid…he has some good ideas. The money becomes available for treatment as attention is drawn to how much money treatment saves society.
    But that’s another story for another time.

  4. Yes, real burdens, real costs, and reflecting the attitude here, just as in society, overlooked by virtually everyone associated with healthcare.
    “Every year, about 20 percent of U.S. adults and children have a mental disorder. Despite an array of effective known treatments, the majority of those with mental disorders do not receive treatment and thus needlessly suffer from distress and disability. Mental disorders are highly disabling, ranking second only to cardiovascular conditions as a leading cause of worldwide disability by the World Health Organization (Murray & Lopez, 1996). Moreover, these disorders impose substantial cost burden to patients, their families, and communities at large. That burden is reflected in lost productivity and premature death in the amount of medical and community resources expended.”
    “About 25 percent of people receiving primary care have a diagnosable mental disorder (Olfson et al., 1997), most commonly anxiety and depression.”
    — Report of a Surgeon General’s Working Meeting on The Integration of Mental Health Services and Primary Health Care (Held on Nov. 30 – Dec. 1, 2000).

  5. With his comment: “This country desperately needs treatment access for mental health, but we can’t even provide enough money for all our physical health needs. We’d rather pay for crime scene cleanup crews to look after mental health neglect.” Peter, above, seems to beleive all of us with mental illness are also criminals. Not so.
    Yes, we desperately need mental health care/coverage in this country. And, I agree that physical and mental health and healhcare cannot be separated. It’s kind of rhetorical to ask–and say–that providing mental health care would reduce for chonic mental illness would reduce expenditures on acute care. Let me share part of my own story:
    As a person diagnosed late in life with bipolar diasease, had I been 1) diagnosed at all 2) diagnosed correctly, 3)treated at all, 4) treated correctly…I would have had three less suicide attempt and 42 years less of a miserable & confused life.
    The cost of multiple hospitalizations, etc. could have been saved had I the correct medical & psychological care to prevent the hospitalizations–that is my case, some poeple will inevitably be hospitalized no matter what, but the majority (at least in my opinion and experience) of mentally ill individuals can be stablized with medication (yes, medication) along with regular and ongoing psychotherapy.
    As for health coverage…I had a bankruptcy two years ago b/c of all my personal expenditures on my own mental health care.
    It took me six full years of persistence on my own behalf and paying out of pocket for ALL my mental health expenses, to finally find the right service providers to help stabilize me so that I now am in a good space and can reflect on the hell I went through, quite a bit in part to the very broken American healthcare system that has a total lack of care, compassion and coverage for mentally ill individuals.

  6. Yes, mental health is more important than most realize. As discussed on this link, “biopsychosocial healthcare” is the integration of biomedical and psychological (mental, behavioral) healthcare. It is an integrated mind-body healthcare approach appropriate for many patients, which that leads to lower overall healthcare expenditures, better treatment outcomes, and enhanced patient satisfaction and well-being for four main reasons:
    > Up to half of all primary care physicians’ cases are either accompanied by, or constitute, psychological problems.
    > Psychological problems cause, exacerbate, or impede healing of many physical illnesses.
    > Psychological treatment helps remedy many physical problems and thus reduces overall medical costs.
    > Behavioral healthcare improves people’s emotional, mental, and physical functioning, which leads to increased productivity and a better quality of life.
    I know of ways to assess important aspects of the mind-body connection using a health IT solution we’ve been discussing since the mid-90’s, but there has been little interest by the mental health community. This is not surprising since mental health appears to be the slowest to adopt IT as a clinical tool. I plan to contact Dr. Kolodner … thanks for the info, Hamish.

  7. This country desperately needs treatment access for mental health, but we can’t even provide enough money for all our physical health needs. We’d rather pay for crime scene cleanup crews to look after mental health neglect.

  8. FWIW, Regarding Mental Health and Health IT:
    The big challenge in this age of increasing HIT is how to integrate mental health with “the body” as it were.
    Just in case you missed this last December,
    David Williams interviewed Dr. Kolodner (National Coordinator for Health Information Technology). http://www.healthbusinessblog.com/?p=1562
    Dr. Kolodner originally worked in the US Veteran Affairs department, where he was the Head of Health IT and electronic medical records. Before that he was involved in Health IT and Mental Health. (Psychiatric residency at Washington University School of Medicine).
    Dr. Kolodner said the following two key challenges are quite different for Mental Health IT compared to Health IT:
    1) Information is Textural and Descriptive. Mental Health is highly dependant on capturing of textural information. This needs to be coded somehow for easier IT use.
    2) Privacy. People are extremely sensitive about their mental health data being made accidentally or deliberately available to others via electronic records. So a balance needs to be found that means personal mental health data is secure, yet does not disadvantage that person in an emergency situation when their details must be accessed.
    Hope this info may help THCB or others in HIT to pick out some fruitful paths to follow regarding mental health. It ain’t an easy nut to crack!
    Hamish MacDonald. Osaka, Japan.