American Hospital Association Special Conference Call How Johns Hopkins Became and Remains a High-Quality Psychiatric Provider Presented by: J. Raymond DePaulo, M.D. and Anita Everett, M.D.

Observations of a Relative Newcomer Anita Everett, MD Section Chief Community and General Psychiatry The Johns Hopkins Bayview Medical Center 2

Organizing Elements Patients Faculty and Staff Administrative System Community Connection 3

PATIENTS Primary, secondary, tertiary care Institutional commitment to uninsured and complex patients 4

FACULTY and STAFF Nursing – respected as professionals Medical National and international experts AND grounded in shared institutional vision Attitude of active participation in regulatory necessities (View compliance as part of supporting the institution) Salaried (supports value for all patients) Embrace clinical challenges and complex problem-solving Respect for decisions administration makes 5

ADMINISTRATIVE SYSTEM Shared vision and commitment to support of clinical mission as well as teaching and education Shared vision regarding the place/position of the institution Institution-wide spirit of cooperation in terms of clinical care, research and teaching. 6

COMMUNITY CONNECTION Maintain good working relationships with state mental health department and other decision- makers in the services system Support of faculty holding organizational leadership roles that increase JHU visibility Hospital generally does a great deal of local community stewardship 7

Thoughts from a Career at Johns Hopkins J. Raymond DePaulo, M.D. Chairman, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine Psychiatrist-in-Chief, The Johns Hopkins Hospital 8

Outline Historical Foundations Culture of Faculty and Staff Policies and Procedures Vision of the Future 9

Our Founding Mission 10 The Aims of a Psychiatric Clinic - Adolf Meyer, 1913 …a psychiatric clinic, therefore, is a hospital for teaching as well as for treatment and study of mental disorder. I should like to see a clinic give one half of its beds to intensive work on a limited district and bestow the other half on intensive work on special clinical problems… With this vision he founded one of the first psychiatric clinics to be fully integrated into academic medicine.

Historical Foundations Mission-driven - Comprehensive care for the community - Treat the most difficult cases in areas of our expertise Trained generations of physician/psychiatrists using an explicitly pluralistic, multidisciplinary approach to patients with a variety of problems Taught concepts of disease, temperment, behavior, and narratives (McHugh and Slavney) that built on Adolf Meyers approach to care of the whole person 11

Culture of Faculty and Staff Clinical work, research, and education are all mutually supportive activities. All clinically trained faculty do clinical work in a teaching setting. Research mission does not drive educational or clinical work. In fact, opposite is true. Culture of collaboration and integration across disciplines, divisions, departments and schools. Because we treat the most complex patients, we have unique experience that continually reinforces expertise. Commitment to excellence in everyday clinical issues in community patients 12

Policies and Procedures The core mission of patient care drives our policy decisions. We look for opportunities to subjugate financial and regulatory burdens to models of care rather than the reverse. The organization of our inpatient units helps to produce not only good care but also models of patient care 13

Disease Burden by Illness - DALY High Income Countries | All Ages | 2004 DALY = Disability-Adjusted Life Year (measures healthy life years loss to premature death and disability) Source: World Health Organization – Burden of Disease Statistics, %

Vision for the Future Our current work and initiatives fall into three major themes: TRANSLATION | Translational Centers in Major Psychiatric Diseases To accelerate translation of genetic and molecular discoveries into rational treatments and accessible models of care for major psychiatric diseases: mood disorders, memory disorders, anxiety disorders, schizophrenia, and autism. PREVENTION | Center for Behavior in Medicine To draw on our expertise in addictions and eating disorders to create prevention strategies for some of the most common and costly medical conditions: obesity, diabetes, heart disease, cancer, HIV. DRUGS AND BEHAVIOR | Center for Substance Abuse Research and Treatment To bring our models of patient care, based on decades of pioneering research on the treatment of opioid dependence to a broader audience 15

Vision for the Future Mental Illness in the 21 st century New molecular methods – genomics and epigenetics – as well as brain imaging, will produce new ways to interrogate the brain to help explain disease mechanisms. Translating this knowledge will enable surer and faster diagnosis and lead to treatments that are rational and more effective. Understanding these disorders will change fundamentally the experience of patients and families. 16

Summary Our history provides continuity and comprehensiveness in patient care Our faculty and staff are mission-driven Our mission and science drive policies Research will guide improvements to patient care 17

Thank You We are happy to answer questions: J. Raymond DePaulo, M.D. Anita Everett, M.D. Beth Ambinder, BSN, MBA Administrator Department of Psychiatry and Behavioral Science 18