Earlier this month, I was honored to attend the 25th Annual Rosalynn Carter Symposium on Mental Health Policy in Atlanta, Georgia. The focus of this symposium every year is to tackle a particular issue in mental health policy, population or care. This year focused, fittingly enough, on health care reform and how mental health and substance abuse programs need to be an integrated part of that effort:
Currently health care in this country is focused on illness rather than health, on procedures and face-to-face interventions rather than on coordination and prevention, and on fragmented, specialty-driven care rather than on a primary care-driven delivery system. There is a solid evidence base that shows that a health system centered on primary care costs less and has better outcomes on a population basis than one dominated by specialty-driven care.
For behavioral healthcare, this kind of system reform poses significant opportunities and challenges, specifically in the scaling up of the evidence-based integration of mental health and substance use treatment and prevention into primary care. Thus, it is through system reform—replacing a fragmented, specialty-dominated system with a more effective and efficient primary care-driven one—that national health care reform may have its greatest impact upon the behavioral healthcare field.
In other words, in order for mental health to be more accepted, primary care physicians — those docs who already see most people with mental health concerns initially anyway — really should be at the forefront of coordinating all of a patient’s care, including their mental health care. I’m not sure I entirely agree with this approach, but it makes a certain sense and is certainly a more elegant option than what currently exists today.
There were six working groups this year, and you can view both the video of the entire symposium and the powerpoint presentations of the working groups’ recommendations online. Since the recommendations are fairly lengthy, I’ll try my best to summarize the salient points from their slides below as succinctly as possible.
- Define and promote a clearly articulated clinical integration model
- This makes it possible to have clearly defined outcomes tied to core payments, with performance incentives
- Financing that supports designs and outcomes (e.g. bundled payments)
2. Children and Adolescents
- Develop a National Children’s Agenda that drives a public health approach that addresses developmentally appropriate needs across the population (including prevention and health promotion).
- Promote the availability of holistic assessments that link the youth and family to services and supports that match developmental needs and promote resiliency and protective factors.
3. Workforce Development
- Expand the concept of who the workforce is and how we train that workforce to work together as equal partners in care in systems that fit the outcomes people desire while being served in their communities.
- The future healthcare workforce will be integrated, networked, collaborative, and community needs-driven, organized around the tenets of population health and the principles of recovery, including primary, secondary, and tertiary prevention, while sharing collective accountability.
4. Cultural and Ethnic Minorities
- Develop an integrated, community-owned health care delivery system that: aligns incentives for financing; supports community-defined evidence; fosters health IT, promotion, and prevention; addresses stigma; has culturally relevant, team-based care; and is accountable and outcomes-driven.
- Expand and improve the capacity of the primary and behavioral care workforce to meet the needs of racially, culturally, and ethnically diverse communities in an integrated setting
- Build a registry for gathering promising practices to guide policy and reforms
- Conduct research on effectiveness of promising practices in the registry
- Use existing data sets to track the impact of health reform (e.g. how does reform impact spending on behavioral health?). Need to give more open and real-time access to data for researchers.
- Develop implementation strategies to ensure widespread dissemination of effective practices
6. Population Health and Prevention
- Advocate that existing task forces work on mental health issues and integration into primary care, as well as revise the evidence standards.
- Health reform money should be used on coordinated mental health promotion efforts.
- Identify groups, including public health advocates, to develop shared language, goals, and resources
- Obtain and fund community-level research on population-based interventions that have evidence, including comparative effectiveness work globally.
What happens next? It’s expected that because the policy summit is attended by the leaders from a wide range of organizations, businesses, and government representatives, they take these policy recommendations back to their respective groups to help guide their organization’s future work. It’s an imperfect system, but you can’t mandate change — you need to persuade it. It usually occurs gradually, in small steps over time.