National Association of State Head Injury Administrators (NASHIA) Public Policy Symposium

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National Association of State Head Injury
Administrators (NASHIA) Public Policy
Symposium
Headlines Why Mental Health Should Be Part of
Health Reform

March 26, 2009

Robert W. Glover, Ph.D. Executive
Director National Association of State Mental
Health Program Directors
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Summary Slide

• Who Are We?
• Who Do We Serve?
• Where Do We Serve Them?
• What is the Link Between Mental Health and
  Health?
• Smoking
• Obesity
• Suicide Prevention
• Returning Veterans

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NASMHPD Represents the 29.5 Billion Public
Mental Health System serving 6.1 million people
annually in all 50 states, 4 territories, and the
District of Columbia. An affiliation with the
approximately 220 State Psychiatric Hospitals
Serve 200,000 people per year and 50,000 people
served at any point in time.
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6.1 Million Persons Served by SMHA Systems 2006

• 96 were served in the Community
• 3.1 served in state psychiatric hospitals
• 22 were Employed
• 48 were not in Labor Force
• 79 lived in Private Residences
• 2.9 were homeless
• 71 reported positive outcomes from their
  services
• 62 had some Medicaid coverage for their Mental
  health services
• 38 had No Medicaid Coverage

2006 URS Reporting
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History of State Hospitals

• In 1954 there were
• 352 state hospitals
• 553,979 Residents in SH at the end of the year
• 178,003 Admissions during the year
• 42,652 Deaths in state hospitals during the year
  (Peaked in 1958 at 51,383 deaths)
• In 2007
• 228 state hospitals (2007 NRI State Profiles)
• 49,000 Residents (2007 NRI State Profiles)
• 174,013 Admissions during the year (2006 URS)
• Deaths not reported

Source CMHS Uniform Reporting System, 2006
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Number of Psychiatric Beds, By Type of Hospital
and Year, U.S. 1970 to 2002
Source Mental Health United States, 2004
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Psychiatric Beds as a Percent of Total Hospital
Beds in the US, 1970 to 2002
In 2002, 1 out of 7 hospital beds in America was
a psychiatric bed
In 1970, 1 out of 3 hospital beds in America was
a psychiatric bed
Source NIMH and NRI
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State Mental Health Agency Controlled
Expenditures for State Psychiatric Hospital
Inpatient and Community-Based Services as a
Percent of Total Expenditures FY'81 to FY'05
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USA Today Front Page Thursday, May 3, 2007
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People with Serious Mental Illness Experience 25
Years Lost Life A Public Health Crisis

• Smoking
• Obesity
• Suicide
• Substance Abuse
• Inadequate Medical Care

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• People reporting a mental disorder in the past
  month consumed approximately 44.3
  of all cigarettes
  smoked in the U.S.
  

Lasser, Karen Boyd, J. Wesley Woolhandler,
Steffie Himmelstein, David U. McCormick, Danny
Bor, David H., "Smoking and mental illness A
population-based prevalence study." JAMA, The
Journal of the American Medical Association.

Nov 22-29, 2000, 284, (20), 2606 - 2610.
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Rates of smoking are 2-4 times higher among
people with psychiatricdisorders and
substance use disorders.
Kalman D, Morissette SB, George TP. American
Journal on Addictions. 2005, 106-123.
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Major depression 50 to 60
Anxiety disorder 45 to 60 Bipolar
disorder 55 to 70 Schizophrenia
65 to 85
Smoking Prevalence among People with Mental
Illnesses
20 of those with schizophrenia started smoking
at college age and many began smoking in mental
health settings receiving cigarettes for good
behavior.

• Presentation at the NASMHPD Medical Directors
  Council Technical Report Meeting on Smoking
  Policy and Treatment at State Operated
  Psychiatric Hospitals, April 20-21, 2006, San
  Francisco, California. DeLeon et al., in press.

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Rates of smoking among treatment staff in mental
health and substance abuse facilities and
programs are higher than other health care
professionals
30-35 of Mental Health Providers Smoke
Primary Care Physicians 1.7 Emergency
Physicians 5.7 Psychiatrists 3.2
Registered Nurses 13.1 Dentists 5.8
Dental Hygienists 5.4 Pharmacists 4.5

• NASMHPD Research Institute, Inc. (2006). Survey
  on Smoking Policies and Practices for Psychiatric
  Facilities.
• Strouse R, Hall J and Kovac M. Survey of
  Health Professionals' Knowledge, Attitudes,
  Beliefs, and Behaviors Regarding Smoking
  Cessation Assistance and Counseling. Princeton,
  N.J.
• Mathematica Policy Research, Inc., 2004, 1-16.

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(Original Source Centers for Disease Control and
Prevention, September 2007)
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Obesity, Metabolic Syndrome, and Diabetes Epidemic
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Diabetes and Gestational Diabetes Trends US
Adults, BRFSS 1990
Mokdad et al. Diabetes Care. 2000231278-1283.
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Diabetes and Gestational Diabetes Trends US
Adults, BRFSS 2000
Mokdad et al. JAMA. 2001286(10).
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Diabetes and Gestational Diabetes Trends US
Adults, Estimate for 2010

No Data Less than 4 4 to 6
Above 6 Above 10
www.diabetes.org.
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Suicide Prevention

• Suicide is the leading cause of violent deaths
  worldwide
• In the United States
• Number of deaths by suicide in 2004 32,439 (CDC
  WISQARS website and Fatal Injury Reports
  http//www.cdc.gov/ncipc/wisqars)
• Deaths per 100,000 population 11.1
• An average of 1 person every 16.2 minutes died by
  suicide.
• Many of them preventable through timely
  intervention.
• National Suicide Prevention Lifeline
• 1-800-273-TALK

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Press 1 for Veterans Services
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Mental Illnesses are Chronic Illnesses that
Impose Great Costs on Our Society

• In 2002, mental illnesses contributed to 193
  billion in lost productivity
• More than the revenue of 499 of the Fortune 500
  companies
• By 2013, this figure is estimated to rise to more
  than 300 billion.
• The World Health Organization has found that
  depression was the fourth leading cause of
  disease-burden in 1990 and by 2020 will be the
  single leading cause.
• Indeed, mental illness is already the leading
  cause of disability for people between 15 and 44
  in the United States and Canada.

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Mental Illnesses are Chronic Illnesses that
Impose Great Costs on Our Society (Cont)

• Data from the Agency for Healthcare Research and
  Quality (AHRQ) shows that expenditures for adults
  with a specific chronic condition AND a mental
  health condition greatly exceed expenditures for
  those without a mental health condition

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Annual Medical Expenditures for Adults with a Specific Chronic Condition, with and without a Mental Health Condition Annual Medical Expenditures for Adults with a Specific Chronic Condition, with and without a Mental Health Condition Annual Medical Expenditures for Adults with a Specific Chronic Condition, with and without a Mental Health Condition
  Cost without mental health condition Cost with mental health condition
All adults 1,913 3,545
Heart condition 4,697 6,919
High blood pressure 3,481 5,492
Asthma 2,908 4,028
Diabetes 4,172 5,559
-Refers to all adults with and without chronic conditions. Information from U.S. Department of Health and Human Services. The 2002 and 2003 MEPS. AHRQ, Rockville, Md. -Refers to all adults with and without chronic conditions. Information from U.S. Department of Health and Human Services. The 2002 and 2003 MEPS. AHRQ, Rockville, Md. -Refers to all adults with and without chronic conditions. Information from U.S. Department of Health and Human Services. The 2002 and 2003 MEPS. AHRQ, Rockville, Md.
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People with Serious Mental Illness Experience 25
Years Lost Life

• People with schizophrenia die from diabetes at
  2.7 times the rate of the general population
• 2.3 times the rate from cardiovascular disease
• 3.2 times the rate from respiratory disease
• 3.4 times the rate from infectious diseases.

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Depression and Other Conditions

• The likelihood of heart attack is four times
  greater for persons with depression than in
  general population the likelihood of stroke is
  2.6 times greater.

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Inadequate Healthcare and Insurance

• Many people with mental health suffer from
  chronic conditions simply because they are not
  receiving appropriate healthcare.
• People with mental illnesses are uninsured at
  twice the rate of the general population 34 of
  people with mental illness have no health
  coverage at this point.
• In other words, many people with mental illnesses
  are excluded from our nations porous healthcare
  system right from the start.

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Mental Health Is Essential to Health Need for
Prevention Approach

• We must also approach prevention across the
  lifespan and work to provide the appropriate
  screens, starting with well-child visits that can
  identify the co-occurrence of mental health and
  chronic conditions.
• It has long been a popular belief that mental
  illnesses begin in late adolescence or early
  adulthood. In fact, this is a misconception.
  The average age of onset for mental disorders is
  14.

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Role of Trauma

• We must develop a better understanding of role
  trauma plays in mental health conditions and then
  employ approaches that mitigate traumas effect.
• We must understand and address maternal
  depression, the consequences it can have on a
  young childs physical and emotional development,
  and the ways it can play out over the span of
  that young childs life.

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Returning Veterans
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Barriers to Care and Mental Health Risk
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I would be seen as weak
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My unit leadershipmight treat me differently
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Members of my unit might haveless confidence in
me
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My leaders would blame mefor the problem
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Screen pos
Screen neg
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It would harm my career
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0
10
20
30
40
50
60
70
80
Agree or Strongly Agree,
Provided by Robert Ursano, M.D.
Participants were asked to rate each of the
possible concerns that might affect your decision
to receive mental health counseling or services
if you ever had a problem. Hoge CW, et al. N
Engl J Med. 200435113-22.
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Barriers to Care and Mental Health Risk(contd)
There would be difficulty getting time off work
for treatment
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It is difficult toschedule an appointment
45
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I dont trustmental health professionals
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I dont know whereto get help
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6
Screen pos
Screen neg
I dont have adequate transportation
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6
0
10
20
30
40
50
60
70
80
Provided by Robert Ursano, M.D.
Agree or Strongly Agree,
Participants were asked to rate each of the
possible concerns that might affect your decision
to receive mental health counseling or services
if you ever had a problem. Hoge CW, et al. N
Engl J Med. 200435113-22.
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• How many Americans have returned from Iraq or
  Afghanistan?
• 1.6 Million Figure does not count
  contractors
• If it were evenly distributed that would be
  30,000 per state.
• If all were combat exposed that might be 6000
  cases of PTSD/Depression per state.
• If ¼ combat then 1500 cases PTSD and TBI (1/6
  combat exposed with TBI) 1250 cases TBI per state.

Provided by Robert Ursano, M.D.
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NASMHPD Presidents Task Force on Returning
Veterans

• Charge To address issues related to the
  provision of mental health services provided to
  veterans (and their families) returning home from
  Iraq and Afghanistan.
• Survey of States Services
• Members
• Commissioners
• Nancy Rollins (New Hampshire)Chair
• Linda Roebuck (New Mexico)
• Mike Lancaster (North Carolina)
• Terri White (Oklahoma)
• Medical Directors
• Alan Radke (Minnesota)
• Jim Evans (Virginia)
• Division Representative
• Joan Smyrski (Maine)

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Returning Veterans NASMHPD Initiatives

• Addressing Issue at NASMHPD Commissioner Meetings
  (Winter 2007, Winter 2008, Summer 2009)
• Veterans Administration on Suicide Prevention and
  Potential Partnering
• SAMHSA Grant Announcement on Jail Diversion and
  Trauma Priority Veterans

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Thank You!