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October 19, 2016

Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities   

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Francine Sinkoff, Editor

Novel Program Effectively Cares for Severely Mentally Ill at Home

A novel way of delivering healthcare services to the severely mentally ill may prevent the predictable downward spiral to homelessness, provided patients have a home where these services can be delivered and a family member who can provide psychosocial support, preliminary results suggest.

"The basis of all our work is the network meeting, which is typically a 90-minute meeting conducted in an open dialogue style with the client, the family, in the patient's home, along with a peer or a social worker or a family therapist or a psychiatrist," James Mills, LCSW, Visiting Nurse Service of New York, in New York City, told Medscape Medical News.
"And we've had great success in engaging people and working with them in a very collaborative, joined way," he added.

Peer Support
The program, known as Parachute NYC, is a community-based mental health initiative that deploys mobile teams to treat seriously mentally ill individuals in their homes.

The team includes current patients - often coming to treatment in crisis, adds David Lindy, MD, clinical director and chief psychiatrist, Visiting Nurse Service of New York - plus at least one unpaid member of the client's natural network, usually a family member, accompanied usually by two staff members.  Read more here .


November 2, 2 - 3 pm

October 21, 2 - 3 pm, NYS OASAS
The Kids' Well-being Indicators Clearinghouse (KWIC), developed by CCF is designed to advance the use of children's health, education and well-being indicators as a tool for policy development, planning, and accountability. The KWIC Team is excited to debut the new MEB indicators as part of New York's effort to identify communities that would benefit from early MEB promotion and prevention services. 
October 25, 1:30 - 3 pm, Open Minds
The Business and Operations of Long Acting Injectable Medications
October 27, 2 - 3 pm, Care Transitions Network



Children & Families Committee
October 25:  11:30 am - 1 pm
GTM Only

RPC Advisory Committee 
October 27:  8 am
GTM Only


Officers & Chairs - Call In
November 2:  8 - 9 am

RPC Advisory Committee 
November 10:  8 am
GTM Only

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
How Gaps In Mental Health Care Play Out In Emergency Rooms

Nearly  1 in 5 children each year suffers a psychiatric illness, according to research estimates. But a national shortage of medical specialists and inpatient facilities means that many still go untreated - despite  national efforts to improve mental health care.

New research is driving home the consequences. Scientific abstracts presented Monday in Las Vegas, at the  annual meeting of the American College of Emergency Physicians, offer insights into how frequently patients with mental health issues land in the emergency room - often because opportunities to intervene earlier are missed. Pediatricians and child psychiatrists say children are among the hardest hit.

The researchers analyzed data compiled by the  National Hospital Ambulatory Medical Care Survey, which tracked mental health visits to hospital emergency departments between 2001 and 2011.

Compared with physically ill patients, people with mental health conditions rely more on the emergency department for treatment and are more often admitted to the hospital from the ER, the scientists found. Also, they tended to be stuck in the ER longer than people who show up in the ER with physical symptoms.

Specifically, the researchers found that about 6 percent of all the emergency department patients - of all ages - had a psychiatric condition. More than 20 percent of these psychiatric patients were admitted to the hospital, compared with just over 13 percent of the medical patients. About 11 percent of these patients with mental health problems required transfer to another facility, compared with 1.4 percent of the patients with physical ailments.  Read more here.
Market Realities Keep Psych Patients Waiting for Care

Health leaders know firsthand how the legacy of deinstitutionalization has resulted in far too many psychiatric patients being stuck in a holding pattern in emergency departments (ED) nationwide, waiting for inpatient beds or some version of immediate specialty care. New data released Monday by the American College of Emergency Physicians (ACEP) helps to quantify the gravity of the issue.

In a poll of more than 1,700 emergency physicians, ACEP found that 48% report that psychiatric patients are held in their emergency departments waiting for an inpatient placement at least once a day, and more than 10% report that on their last shift alone, there were six to 10 patients waiting. How long is the wait? Twenty-one percent say it's two to five days.

Five days is a long time for a patient with bipolar disorder or severe depression to wait for care, and the ED-with its round-the-clock activity, artificial lighting and alarming noises-is not exactly the ideal atmosphere for recovery, said Rebecca Parker, MD, FACEP, president of ACEP, in a call with reporters. She also noted that the ED has become the "dumping ground" for psychiatric patients.   Read more here .
The New Focus on Children's Mental Health 

Across the United States, up to  one in five  children suffers from a mental disorder in a given year, according to the Centers for Disease Control and Prevention. This 
equates to  more than 17 million young people who meet criteria for disorders that affect their ability to learn, behave, and express their emotions.

Giving children access to mental-health resources early in their education, however, can play a key role in mitigating negative consequences later in life, said David Anderson, the senior director of the ADHD and Behavior Disorders Center at the Child Mind Institute.

"It's during childhood and adolescence where we have a large concentration of mental-health issues, and school is where many kids are spending a large portion of their day. That makes school the perfect place to focus mental-health resources," Anderson said. "Waiting too long to pay attention to student mental health can easily lead to school dropouts or other problems later in life."

Yet the majority  of the nation's youngest students don't have access to mental-health resources at school. Only 23 percent of prekindergarten programs have on-site or scheduled visits from psychiatrists or psychologists, according to the Child Mind Institute's  2016 Children's Mental Health Report . The current shortage of mental-health professionals, which is expected to continue, only exacerbates the problem. The  Substance Abuse and Mental Health Services Administration  projects that 12,624 child and adolescent psychologists will be needed to meet demand by 2020, but a supply of only 8,312 is expected.  Read more here.
Grant Supports Local In-Home Visit Program for Older Adults with Behavioral Health Needs in Finger Lakes

Older adults in the Rochester and surrounding Finger Lakes area report more "poor mental health" days than their peers across New York state, a fact compounded by a shortage of behavioral health providers in the region. But a new interprofessional collaborative program has the potential to better address seniors' complex health needs.

A grant from the National Center for Interprofessional Practice and Education provides the initial start-up funding for an innovative geriatric home visit (GHV) initiative which will pair local nurse practitioner and medical students with social workers to provide in-home behavioral screenings to older adults, leading to the development of an integrated physical, behavioral, and social support care plan.

The project broadens access to behavioral health assessments among vulnerable older adults while building a workforce of health professionals better able to identify and collaboratively manage the population's health needs using new models of care delivery.   Read more here .
Diverse Medicaid Rules Hurt in Fighting Addiction

In an opioid epidemic that is killing tens of thousands of people nationwide, finding and paying for addiction treatment remains a challenge for low-income Americans, particularly in the South and parts of the West.

The Affordable Care Act required Medicaid, the joint state-federal health program for the poor, to start paying for all available substance abuse treatments in 2014, a provision seen as a boon for low-income people who previously were not covered for addiction treatment.

But Medicaid coverage of the most widely used opioid addiction medication, buprenorphine, varies widely among states. Many doctors don't want to treat Medicaid patients for addiction. And red tape can make it difficult for many Medicaid recipients with addictions to get effective treatment.
All this has consequences as the nation battles the epidemic. As a group,  Medicaid enrollees suffer from opioid addiction and other substance abuse disorders at a higher rate than the general population.

"What we see in far too many Medicaid plans are restrictions and approaches to addiction treatment that are not in line with the way we treat other diseases," said Dr. Kelly Clark, president-elect of the American Society of Addiction Medicine (ASAM). "Some plans require patients to wean off of their addiction medications. Would you tell a heart patient he needs to taper off of his medication after a year?"

All states reimburse for the medication, but in many places, the fees Medicaid pays doctors are considered too low and the paperwork too time-consuming to attract  an adequate number of providers willing to treat Medicaid enrollees with addictions.  Read more here.
To Get This Job, a Former Life as an Addict is Required

She was in her early 20s, homeless and in heroin's grip, when Nicole Bourgeois moved in underneath the Longfellow Bridge, with a view of Massachusetts General Hospital.

For a few months, she slept on a mattress hidden on grates below the subway stop there. When she was hungry or cold, she took food from the Mass. General cafeteria or warm blankets from the emergency room. She lifted Vera Bradley bags in the gift shop to sell later.

Last week, Bourgeois, her MGH employee badge around her neck, attended meetings with doctors and other co-workers, assisted patients, and co-led education groups with a hospital pharmacist. Bourgeois, 32, is one of seven former drug users hired recently by the hospital to work as "recovery coaches'' - a profession poised to take off nationwide amid the pressing need for more effective substance abuse treatment.

A struggle with addiction is not a red flag for employment but rather a job requirement.
Mass. General is one of the first US hospitals to embed recovery coaches on care teams. Drug treatment centers are increasingly hiring coaches as well, and cities hit hard by the opioid epidemic are sending these coaches out to the homes of residents who have overdosed and into police station holding cells.

The irony of her employment  is not lost on Bourgeois, who was banned from Mass. General property during the worst years of her addiction.  Read more here.
The Conference of Local Mental Hygiene Directors advances public policies and awareness for people with mental illness, chemical dependency and developmental disabilities.  We are a statewide membership organization that consists of the Commissioner/ Director of each of the state's 57 county mental hygiene departments and the mental hygiene department of the City of New York.