CMHS National Mental Health Statistics Conference
Washington, DC, May 01
Manderscheid: "There can be no quality services without data on quality."
Barry: New HHS Deputy, Claude Allen. Block grants will be "performance partnership" grants and will call for the collection of uniform data.
Arons: Data infrastructure grants available for each state. CMHS created in '92. Work coming to fruition. Targeted capacity expansion (TCE) grants to deliver m h services in non-specialty settings.
Corrigan: the American healthcare delivery system is seriously broken and building an infrastructure is critical to improving quality. Hospital medical errors account for from 44K - 98 K; probably under-estimated (IOM Study); errors arise from *system* failures. Rand: Large gaps between the care people should receive and the care they do receive. Patients should be in the driver's seat. If disagreement, medical effectiveness comes before the patient's desires. Healthcare is a service industry; with a good design, delays should be eliminated. Provider:patient e visits and email use won't increase 'til providers are compensated for e time. Proposed system will be transparent, patients will have record access. Internet has enormous potential to transform health care, and to make it more patient-centered. Eliminate handwritten clinical data by 2010.
I moderated a session on Software for Patient Empowerment, and public key encryption/infrastructure. One of the presenters described the system he sells, in which the patient answers an electronic questionnaire which then generates an intake report for the physician. An example was the system's successful use in a retreat house for alcoholic priests. Emphasized was how much physician time was saved by not having to ask screening questions and listen to answers. (On average, a physician listens for 22 seconds before interrupting the patient.) The presenter made clear that "these people," people in institutions, crazy people, couldn't fill out an electronic form, that people with disabilities were a "special case," patient labor was free and hence even less costly than low income workers, e.g. immigrants, And more along that vein. Paolo finally spoke up, forcefully, also Larry Fricks and Randy Hack. This same presenter, one of three, started the session without letting me even welcome and start us off, stood in front of me during the question time so that I had to walk into the audience to moderate him and the discussion, ... And I was pleased at being asked to moderate, thought it would be fun! I talked to him a bit at the end; he didn't hear what I was saying any better than what the audience had said about language and attitude, and as he walked out, was comforted by a man from a state m h department whom I overheard him say "They would be like that regardless." I felt deeply wounded. Later, at the reception, we spent time together, I told him a bit about my life, people's lives, he was stunned, had never heard our stories about misused dx, records, effects of force, ... I think his eyes *may* be opened a bit. And the next day he and I had another conversation which he initiated. He said this conference was a big learning experience for him, I suggested that people aren't psychotic 24/7, that people providers couldn't talk to might communicate with peers, ... and that third conversation led to his planning a research project to do electronic psychiatric intake interviews, maybe even at home as symptoms begin, before the forced intervention and escalation. It's all been a learning experience for me, and for him.
20, at least six new faces. Names I know: Andrea Stephenson, OR; Randy Hack, HI; Gayle Bluebird, FL; Kevin Fitts, OR: Laura Van Tosh, MD: Venita Johnson, OK; Larry Fricks, GA; Larry Belcher, WV: John Stringfellow, WV; Boyd Tracey, Katsumi Keniston; John Delman, Andrea Cooke, and a few whose names I don't know. Iris Hyman, Paolo del Vecchio, Carole Schauer, Neal Brown. Gathering input for national TA center GFA's to be prepared by Jan 02. Also, Greenwood-Kaptur proposes regional TA centers, if passed, authorizes $5 million a year for 10 centers.
Other consumers and survivors here: Jean Campbell, MO: Mo Armstrong, MA: Martha Anderson, UT; J Rock Johnson, NE; Juli Lawrence..
Audience: HCFA isn't taking m h consumer input seriously on Olmstead implementation committees. Teach consumers what "outcomes" are and what the process is. Are there services for GLBT? (GLBT = Gay, lesbian, bisexual, transgendered)
Three CMHS standing review committees, knowledge application, knowledge development, cross-cutting issues. Membership will be supplemented depending on types of grants.
Onken: recovery project - what helps and what hinders (I am asking for e versions of the overheads) This is inclusive work using an organic process. Focus groups have been held to gather input about 1) resources/basic needs; 2) choices/self-determination; 3) independence/sovereignty; 4) interdependence/connectiveness; 5) hope.
Changing stereotypes/prejudices/discrimination: Education yields some changes on attributions specific to mental illness. Contact yields better changes on attributions and behaviors.
News: Bill Compton is being awarded the annual NMHA Clifford Beers Award
Better quality of housing leads to better mental health results; housing in mixed, "disorganized" neighborhoods leads to better outcomes. Housing and mental illness literature review will be out soon, published by the Urban Institute. RWJ non-profit independent housing development project successful.
Next tech step: not tethered, but mobile data input.
Anti-depressant meds aren't being prescribed at therapeutic level - expensive urine.
Greenberg, (American Managed Behavioral Healthcare Association (AMBHA) , working with SAMHSA on integrating primary care and m h care. But AMBHA wants to maintain the positive (cost-saving) aspects of carve-outs. Privacy is a roadblock to providers talking to each other about patients. Greenbergp@erols.com
Olmstead implementation coalition has more than 60 members. 41 states have already applied for state coalition grants.
Gulbinat: develop MNH (mental health) policies in countries that don't have them. Move MNH to international health agenda. World Health Report 2001 devoted to MNH, will be released in October. Tools needed: MNH country profile - MNH status, evidence base for priority setting - what is the burden, why does it still exist, what types of interventions exist and how cost effective are they; MNH policy template. Recent Institute of Medicine (IOM) report on neurological, psychiatric and developmental disorders in developing countries www.world-mental-health.net www.globalforumhealth.org Templates will have impact on US. 15 developing countries so far involved.
www.bhvendors.org behavioral health vendor consortium
www.hcp.med.harvard.edu/echo/home.html - consumer survey designed to rate treatment and counseling services could become universal survey for the field
www.wspartners.com, Club of Geneva, mental energy at work, employee assistance programs (EAP) global trade organization
Venita Johnson won a Visor and keyboard.
Mritsugu: More people die at their own hands than at the hands of others. Balkanized and stove-piped healthcare system needs mental health integrated into primary care. (He's a caring and moving speaker.)
Ray: Predict often; put nothing in writing. 40 % of behavioral health workers have a computer at their desks. 90% of them have computers at home. Prediction: human will be cloned. Currently organs are cloned in Russia; cost about $200, 000. Prediction: out of pocket healthcare costs will increase. Currently *no* ethnic majority in California. More providers will be para-professionals and entry-level workers. Information technology (IT) is essential. Most people in public sector have 56K lines. Cost, not value, is driving the public interest. 61% of Medicaid recipients are in managed care. Private employer m h benefits spending per year has steadily declined ('97 - $69 per employee.) Cost shifting to public sector. Resource based policy: who gets what, under what circumstances, for how long, at what cost, for what outcomes. Public policy perpetuates outmoded practices.
Self-paid healthcare boutique services. Private: ill more than 14 days shifted out of healthcare and into short-term disability. Uninsured numbers growing. Costs of pharmaceuticals driving out the funding for wrap-around services.
Banks: Virtual Management Information System (MIS) using counts based on extrapolations from birthdays.
Speaker: Self-rating of ill health is a good indicator of death of that person in the coming year.
Wackwitz: How strengths and supports forecast outcome. Profile correlates with received services. Services correlate with outcomes. All correlates with individual's strengths and supports. Seven areas associated with strengths.