Transforming the Mental Health System Linking General Health and Mental Health: Considerations from Two Reports 1/3/2019 Prepared by Ted J. Johnson, M.A.

Prepared by Ted J. Johnson, M.A. SOURCE From Policy to Service: A Quality Vision for Behavioral Health Using the Quality Chasm and New Freedom Commission Reports as a Framework for Change - American College of Mental Health Administration 1/3/2019 Prepared by Ted J. Johnson, M.A.

Prepared by Ted J. Johnson, M.A. Overview Consensus Current health systems do not work Current health systems are in need of fundamental reform 1/3/2019 Prepared by Ted J. Johnson, M.A.

Prepared by Ted J. Johnson, M.A. Quality Chasm Series Produced by Institute of Medicine 2000 – 2003 1/3/2019 Prepared by Ted J. Johnson, M.A.

Quality Chasm Series (continued) Role of federal government and the role of performance measurement in purchasing healthcare Leadership by Example: Coordinating Government Roles in Improving Health Care Quality, 2002 Promising Quality Improvement Conditions Priority Areas for National Action: Transforming Health Care Quality, 2003 1/3/2019 Prepared by Ted J. Johnson, M.A.

Quality Chasm Series (continued) Review of medical errors To Err is Human, 2000 Examination of quality Crossing the Quality Chasm: A New Health System for the 21st Century, 2001 Examination of Health Disparities Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 2002 1/3/2019 Prepared by Ted J. Johnson, M.A.

Obstacles to Quality Mental Health Care Stigma surrounding mental illnesses Unequal limitation and financial requirements placed on mental health benefits in privately insured health care Fragmented mental health delivery system – Charge to New Freedom Commission, 2003 President George W. Bush 1/3/2019 Prepared by Ted J. Johnson, M.A.

Institute of Medicine Assertions Incremental Change – trying harder with existing models – will not work Reform can only be achieved through fundamental change or transformation 1/3/2019 Prepared by Ted J. Johnson, M.A.

President’s New Freedom Commission Six goals Americans understand that mental health is essential to overall health Mental health care is consumer and family driven Disparities in mental health services are eliminated Early mental health screening, assessment, and referral to services are common practice Excellent mental health care is delivered and research is accelerated Technology is used to access mental health care and information 1/3/2019 Prepared by Ted J. Johnson, M.A.

Prepared by Ted J. Johnson, M.A. Institute of Medicine Core values for healthcare: Safe Person-centered Efficient Effective Timely Equitable 1/3/2019 Prepared by Ted J. Johnson, M.A.

Prepared by Ted J. Johnson, M.A. Institute of Medicine Ten rules to guide and direct the delivery of care: Care is based upon continuous healing relationships Customization is based on patient needs and values The patient is the source of control Shared knowledge and the free flow of information is essential 1/3/2019 Prepared by Ted J. Johnson, M.A.

Prepared by Ted J. Johnson, M.A. Institute of Medicine Ten Rules (continued) Decision-making is evidence based Safety is a system priority There is a need for transparency in all aspects of healthcare delivery Needs are anticipated The reduction of waste is ongoing Cooperation among clinicians is a priority 1/3/2019 Prepared by Ted J. Johnson, M.A.

Prepared by Ted J. Johnson, M.A. Four Levels = Focus of Change Berwick, D.M. 2002. A User’s Guide for the IOM’s ‘Quality Chasm’ Report. Health Affairs (Millwood) 21 (3):80-90 LEVEL Experience of Patients and Communities Micro-systems of Care Healthcare Organizations Public Environment IMPACT Recipients of care Direct care providers Larger health systems Policy, financing, and regulations 1/3/2019 Prepared by Ted J. Johnson, M.A.

Institute of Medicine Quality Chasm Report Activities and opportunities for immediate focus: Applying evidence to the delivery of healthcare services Using information technology Aligning payment policies with quality improvement Preparing the workforce to follow the rules and achieve the aims 1/3/2019 Prepared by Ted J. Johnson, M.A.

New Freedom Commission Goals and Objectives 1. Americans understand that mental health is essential to overall health. 1.1 Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention. 1.2 Address mental health with the same urgency as physical health. 2. Mental health is consumer and family driven. 2.1 Develop an individualized plan of care for every adult with a serious mental illness and child with a serious emotional disturbance. 2.2 Involve consumers and families fully in orienting the mental health system toward recovery. 2.3 Align relevant Federal Programs to improve access and accountability for mental health services. 2.4 Create a comprehensive State mental health plan. 2.5 Protect and enhance the rights of people with mental illness. 1/3/2019 Prepared by Ted J. Johnson, M.A.

New Freedom Commission Goals and Objectives 3. Disparities in mental health services are eliminated. 3.1 Improve access to quality care that is culturally competent. 3.2 Improve access to quality care in rural and geographically remote areas. 4. Early Mental Health Screening, Assessment, and Referral to Services are Common Practice. 4.1 Promote the mental health of young children. 4.2 Improve and expand school mental health programs. 4.3 Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies. 4.4 Screen for mental disorders in primary health care across the life span, and connect to treatment and supports. 1/3/2019 Prepared by Ted J. Johnson, M.A.

New Freedom Commission Goals and Objectives 5. Excellent Mental Health Care is Delivered and Research is Accelerated. 5.1 Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illness. 5.2 Advance evidence-based practices using dissemination and demonstration projects and create a public –private partnership to guide their implementation. 5.3 Improve and expand the workforce providing evidence-based mental health services and supports. 5.4 Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care. 1/3/2019 Prepared by Ted J. Johnson, M.A.

New Freedom Commission Goals and Objectives 6. Technology is used to access mental health care and information. 6.1 Use health technology and telehealth to improve access and coordination of mental health care especially for Americans in remote areas or in underserved populations. 6.2 Develop and implement integrated electronic health record and personal health information systems. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Comparing IOM with President’s New Freedom Commission IOM Aims Commission Recommendations Safe 1.1 Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention. 2.5 Protect and enhance the rights of people with mental illness. Person-Centered 2.1 Develop an individualized plan of care for every adult with a serious mental illness and child with a serious emotional disturbance. 2.2 Involve consumers and families fully in orienting the mental health system toward recovery. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Comparing IOM with President’s New Freedom Commission IOM Aims Commission Recommendations Effective 4.2 Improve and expand school mental health programs. 4.3 Screen for co-occurring mental and substance abuse disorders and link with integrated treatment strategies. 4.4 Screen for mental disorders in primary health care, across the life span, and connect to treatment and supports. 5.2 Advance evidence-based practices using dissemination and demonstration projects and create a public -private partnership to guide their implementation. 5.3 Improve and expand the workforce providing evidence-based mental health services and supports. 5.4 Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Comparing IOM with President’s New Freedom Commission IOM Aims Commission Recommendations Efficient 2.3 Align relevant Federal Programs to improve access and accountability for mental health services. 2.4 Create a comprehensive State mental health plan. 6.2 Develop and implement integrated electronic health record and personal health information systems. Equitable 3.1 Improve access to quality care that is culturally competent. 3.2 Improve access to quality care in rural and geographically remote areas. 4.1 Promote the mental health of young children. 6.1 Use health technology and telehealth to improve access and coordination of mental health care especially for Americans in remote areas or in underserved populations. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Comparing IOM with President’s New Freedom Commission IOM Aims Commission Recommendations Timely 1.2 Address mental Health with the same urgency as physical health. 5.1 Accelerate research to promote recovery and resilience and ultimately to cure and prevent mental illness. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Understanding the IOM Aims Safe: Services are provided in an emotionally and physically safe, compassionate, trusting and caring treatment/working environment for all clients, family members and staff. The IOM aim of safety is addressed within two of the larger goals of the President’s Commission. These include: 1) The understanding that mental health is essential to overall health. 2) That mental healthcare is consumer and family driven. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Understanding the IOM Aims Person-Centered: A highly individualized comprehensive approach to assessment and services is used to understand each individual’s and family’s history, strengths, needs and vision of their own recovery including attention to the issues of culture, spirituality, trauma and other factors. Service plans and outcomes are built upon respect for the unique preferences, strengths and dignity of each person. Two specific recommendations from the President’s Commission further elaborate on and address this issue. This includes the call for: 1) An individualized plan of care for adults and children with mental health needs. 2) The involvement of both recipients of care and their families in an orientation towards recovery. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Understanding the IOM Aims Effective: Up -to- date evidence -based services are provided in response to and respectful of individual choice and preference. The aim of effectiveness care is linked to two of the Commission’s goals. These include: 1) The common practice of early mental health screening, assessment and referral for services. 2) Along with the expectation that excellent care is delivered and research is accelerated. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Understanding the IOM Aims Efficient: Human and physical resources are managed in ways that minimize waste and optimize access to appropriate treatment. The IOM aim of efficiency states that health systems should avoid waste, including equipment, supplies, ideas, and energy. There are two goals in the Commission report that support this aim: 1) Mental health care should be consumer and family driven. 2) Technology is used to access mental health care and information. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Understanding the IOM Aims Equitable: Access and quality of care do not vary because of client or family characteristics such as: race, ethnicity, age, gender, religion, sexual orientation, disability, diagnosis, geographic location, socioeconomic status or legal status. The Quality Chasm aim of equity is articulated in three of the Commission’s goals: 1) The elimination of disparities in mental health services, early mental health screening. 2) Assessment and referral services are common practice. 3) The use of technology to access mental health care and information. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Understanding the IOM Aims Timely: Goal-directed services are promptly provided in order to restore and sustain clients and families integration in the community. The aim of timeliness is the focus of two of the Commission’s goals: 1) Americans understand that mental health is essential to overall health. 2) Excellent mental health care is delivered and research is accelerated. 1/3/2019 Prepared by Ted J. Johnson, M.A.

Applying Evidence to The Delivery of Healthcare An average of 17 years for new knowledge to be incorporated into practice Incorporating new knowledge into practice is uneven and inconsistent Evidence-based care Must be a part of any redesign process Linked to all other areas of the system and any change processes 1/3/2019 Prepared by Ted J. Johnson, M.A.

The Use of Information Technology Use of technology to improve access and coordination of care Integration of personal health information Guidelines for privacy and security of protected health information (HIPAA) 1/3/2019 Prepared by Ted J. Johnson, M.A.

Aligning Payment Policies with Quality Improvement Accreditation Clear and consistent vision of quality Core performance measures 1/3/2019 Prepared by Ted J. Johnson, M.A.

Preparing the Workforce Quality Chasm Report and the President’s New Freedom Commission Serious problem in the development and deployment of the professional workforce Educational systems that prepare the workforce fail to keep pace with changes System reform will require significant changes in the behavioral health and general healthcare fields 1/3/2019 Prepared by Ted J. Johnson, M.A.