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Anyone can have a mental illness, regardless of age, gender, race, or income. Mental illnesses are more common than cancer, diabetes, heart disease, or AIDS. It is believed that one in five adults and children has a diagnosable mental disorder, one in every 10 young people age 9 or older has a serious emotional disturbance that severely disrupts daily life.and one in four families will have a member with mental illness. Children who develop depression often have a family history of the illness, many times a parent who had depression at an early age. Untreated mental health problems can lead to suicide, which is the sixth leading cause of death for 5- to 14-year olds. An estimated two-thirds of all young people with mental health problems are not getting the help they need.It is important to remember that mental illness occurs at any age, but most often appears for the first time between the ages of 25 and 44. With proper treatment, most people suffering from a mental illness can return to normal, productive lives, and almost everyone receives some benefit from treatment.

The causes of mental illness are complicated. Mental health disorders in children and adolescents are caused mostly by biology and environment. Examples of biological causes are genetics, chemical imbalances in the body caused by genetics, lack of sleep or poor nutrition, or damage to the central nervous system, such as a head injury, lack of oxygen in child birth and fetal alcohol spectrum disorders. Many environmental factors also put young people at risk for developing mental health disorders. Examples including exposure to environmental toxins, such as high levels of lead; exposure to violence, such as witnessing or being the victim of physical or sexual abuse, drive-by shootings, muggings, or other disasters; stress related to chronic poverty, discrimination, or other serious hardships; and the loss of important people through death,divorce, or broken relationships.

The following six preventive services are recommended and can be carried out in a clinic, church, library or local community center:

1. Prenatal and infancy home visits or support groups.

2. Targeted cessation education and counseling for smokers, especially those who are pregnant.

3. Targeted short-term mental health therapy.

4. Self-care education for adults (money management, relationship skills, stress management).

5. Mentoring and adult supervised after-school and weekend programs

6. Brief counseling and advice to reduce alcohol use.

Over the years I have found that finding good information is kind of like trying to find a needle in a haystack. The following links will take you to addictions and mental health sites that have the most current and useful information for addictions counselors, rehabilitation counselors, mental health clinicians, nurses and (of course) program administrators. All of the resources are FREE so you can order copies for your colleagues and/or staff!

Clinical Preventive Services in Substance Abuse and Mental Health Update: From Science to Services http://mentalhealth.samhsa.gov/publications/allpubs/SMA04-3906/ This report has been prepared to summarize the most promising preventive interventions of a behavioral nature intended to impact mental and substance use disorders, or in some cases, medical outcomes. This review focuses on prevention interventions that are primarily delivered by health care systems. Interventions provided in schools, worksites, communities, and criminal justice systems were excluded, as were population-based interventions.Clinical

Preventive Services in Substance Abuse and Mental Health Update: From Science to Services Special Report: Preventive Interventions Under Managed Care: Mental Health and Substance Abuse Services http://mentalhealth.samhsa.gov/publications/allpubs/SMA00-3437/SMA00-3437ch1.asp Programs and services that prevent substance abuse and mental health disorders have the potential to lessen an enormous burden of suffering and to reduce both the cost of future treatment and lost productivity at work and home. The availability and accessibility of these interventions to the millions of Americans whose health care is provided by managed care organizations depend upon the services’ status as covered benefits.

Get Connected! Toolkit (Linking Older Adults With Medication, Alcohol, and Mental Health Resources) http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=16523 Alcohol, medication misuse, and mental health problems can be significant issues for older adults. This kit is designed to enable their service providers to undertake health promotion, advance prevention messages and education, and provide screening and referral for mental health problems and the misuse of alcohol and medications. The kit includes a coordinator’s guide and program support materials such as education curricula, fact sheets, handouts, forms, and resources.

Fetal Alcohol Spectrum Disorders (FASD): The Basics (CD Rom) http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17296 This mini CD—consisting of slides and accompanying notes—provides the latest and most accurate information on Fetal Alcohol Spectrum Disorders or FASD. The CD includes essential facts on what FASD is, how it’s caused, how many people have it, and much more.

Quick Guide for Clinicians Based on TIP 47, Substance Abuse: Clinical Issues in Intensive Outpatient Treatment http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17615 This pocket-sized booklet concisely presents information from TIP 47, including the principles of intensive outpatient treatment (IOT), the services offered, treatment engagement, clinical issues and challenges, and the approaches used in IOT.

TIP 46: Substance Abuse: Administrative Issues in Intensive Outpatient Treatment http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17440 This Treatment Improvement Protocol (TIP), Substance Abuse: Administrative Issues in Outpatient Treatment, was written to help administrators address the changing environment in which outpatient treatment programs operate. The TIP provides basic information about running an outpatient treatment program, including strategic planning, working with a board of directors, relationships with strategic partners, hiring and retaining employees, staff supervision, continuing education and training, performance improvement, outcomes monitoring, and promotion of the program to potential clients, funding agencies, and government officials. More specialized sections address challenges that have emerged and gathered importance in the last decade: preparing a program to provide culturally competent treatment to an increasingly diverse client population and succeeding in a managed care-dominated world by diversifying the funding sources a program draws on.

TIP 45, Detoxification and Substance Abuse Treatment http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17398 TIP 45 provides lists and tables related to such topics as initial evaluation domains for clients in detoxification, guidance on assessment and rehabilitation planning, and the management of intoxication and withdrawal from specific substances or substance groups such as alcohol, marijuana, stimulants, and opioids.

TIP 44: Substance Abuse Treatment for Adults in the Criminal Justice System http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17183 Research consistently demonstrates a strong connection between criminal activity and substance abuse; research also finds that involvement in substance abuse treatment reduces recidivism for offenders who use drugs. This TIP presents clinical guidelines to assist counselors in dealing with problems that routinely arise because of their clients’ status in the criminal justice system.

Good resources for teachers and parents regarding mental health and addictions can also be hard to come by. Additionally, many parents have a hard time sticking with programs because day-to-day things come up—working late, homework whatever. It is often more effective to use these materials in a group setting. Not only does it allow the parents and children to spend time together, but families can provide social support to one another. The following FREE resources are available for order and/or download and can be easily used in a classroom, homeschool or church setting.

Drugs, Brains, and Behavior – Science of Addiction http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17602 (As seen on HBO’s Addiction: Communities Take Action) This landmark publication provides scientific information about the disease of drug addiction, including the many harmful consequences of drug abuse and the basic approaches that have been developed to prevent and treat the disease, and aims to increase understanding of the basics of addiction to help people make informed choices in their own lives, adopt science-based policies and programs that reduce drug abuse and addiction in their communities, and support scientific research that improves the Nation’s well-being.

Building Blocks for a Healthy Future Family Guide http://media.shs.net/bblocks/ParentGuideLong.pdf

The Building Blocks Family Guide contains ideas for fun activities and discussion starters for you and your children, as well as advice and guidance on topics such as active listening, rule making, and being a good role model. It also can be used to guide you through the rest of the Building Blocks materials with your children.

Brain Power! The NIDA Junior Scientist Program: Grades K-1 http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=16883; Grades 2-3 http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=16037; Grades 4-5 http://www.drugabuse.gov/JSP3/JSP.html The Brain Power! program takes students step by step through an exploration of the processes of science and how to use these processes to learn about the brain, the nervous system, and the effects of drugs on the nervous system and the body. The materials include a videotape, a teacher’s guide, trading cards, and parent newsletters.

Fetal Alcohol Spectrum Disorders (FASD): The Basics (CD Rom) http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17296 This mini CD—consisting of slides and accompanying notes—provides the latest and most accurate information on Fetal Alcohol Spectrum Disorders or FASD. The CD includes essential facts on what FASD is, how it’s caused, how many people have it, and much more.

Family Guide to Systems of Care for Children With Mental Health Needs http://mentalhealth.samhsa.gov/publications/allpubs/sma05-4054/ Caring for Every Child’s Mental Health Campaign is a national public education initiative emphasizing attention to children’s and adolescents’ mental health. It supports the Comprehensive Community Mental Health Services for Children and Their Families Program, in place in communities across the Nation, which is demonstrating the effectiveness of systems of care in meeting the services needs and improving the lives of children with serious emotional disturbances (SEDs) and their families. This campaign is managed by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S.

Department of Health and Human Services. The guide is intended to help parents and caregivers seek help for children with mental health needs. Information is provided on what parents and caregivers need to know, ask, expect, and do to get the most out of their experience with systems of care.

Reach to Teach Educating Elementary and Middle School Children with Fetal Alcohol Spectrum Disorders http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17603 Reach To Teach is a resource guide for parents of a child with an FASD and for teachers in elementary and middle schools who work with children who have an FASD. It provides a basic introduction to these disorders and tools to improve communication between parents and teachers.

Heads Up: A website with .pdf printables from scholastic publishers. http://teacher.scholastic.com/scholasticnews/indepth/headsup/support/index.asp?article=reproducibles

Real News About Drugs and Your Body. Here you’ll find real, science-based facts about the effects drugs have on the teen brain and body. Check out the articles and features below to get the latest facts so you can make smart choices about your health.

Improving the Mental Health System

According to a news release that was dated May 9, 2006, the “Standing Senate Committee On Social Affairs, Science and Technology” in Canada recommended the creation of a Canadian Mental Health Commission that will be responsible for significantly upgrading the Canadian mental health system. As stated by Senator Michael Kirby, the Chair of the Committee, “The Senate Committee is committed to improving the range, quality and organization of health and support services that are required by the tens of thousands of Canadians who are living with mental illnesses and addictions.”

Funding The Proposed Change

Based on an extensive three-year study on mental health and addiction, the Committee determined that it will cost $5.36 billion over a 10-year period for this mental health system upgrade. Where will these funds come from? According to the Committee, the revenue will come from raising the excise tax on alcoholic drinks by 5 cents per drink.

Part of the rationale for the 5-cent increase per drink was obviously the goal of raising the needed funds for the proposed changes in the mental health system. Another justifying factor for the price increase, however, was the fact that since each alcoholic drink will cost more, Canadians will be more inclined to drink lower-alcohol products such as beer and wine instead of liquor.

Let’s Do the Math

At first glance, this proposal seems to make sense. Why shouldn’t those who drink help finance a program that will provide them with a better mental health system? Why not let those who are part of the “problem” become part of the “solution”? This logic seems sound until you do the math. If $5.36 billion is needed to help finance the upgraded mental health system, then how many drinks will have to be consumed in a ten-year period to reach $5.36 billion dollars? The answer: 107,200,000,000 drinks. That’s 107 billion, 200 million drinks.

To arrive at how many drinks this is per year, all we have to do is divide this number by 10 (for the ten-year program) and the result is 10,720,000,000. This is still a huge number that fortunately can be “massaged” even more. According to The World Factbook website, the population of Canada was estimated to be 33 million people in 2006. Dividing 10,720,000,000 by 33,000,000 equals 325. Putting this in terms that the average person can understand, every man, woman, and child in Canada will have to consume 325 alcoholic drinks per year for the next ten years to finance the new mental health system! Simply put, these numbers are not realistic.

More Flaws

The “logic” of this proposed mental health program also breaks down when it is examined more deeply. For instance, why would people drink lower-alcohol products such as beer if the increased excise tax applies to all alcoholic drinks? To help understand this better, let’s use an example. Let’s say that the average shot in Canada currently costs $3.00 and the average beer costs $1.00. Based on the proposed price increase, if Joe drinks an average of 5 shots per week, his weekly average alcohol expenditure will be $15.25. When the numbers are calculated, this figures out to be 1.7% more than Joe would have spent before the proposed tax increase. Let’s do a similar exercise with beer. Based on the projected price increase, if Pete drinks an average of 5 beers per week, his weekly average alcohol expenditure will be $5.25. When the numbers are calculated, this figures out to be 5% more than Pete would have spent before the proposed tax increase. The point: since the proposed price increase affects higher-alcohol products (such as shots) proportionately less than their lower-alcohol counterparts (such as beer), why would Canadians switch to lower-alcohol products?

Alcohol and Mental Health

Another question. What if tens of thousands of Canadians, realizing that drinking alcohol is not good for their “mental health,” significantly reduce their alcohol intake or quit drinking alcoholic beverages altogether? Where will the money come from to offset this lack of revenue? In a similar manner, what if thousands upon thousands of Canadians who drink alcoholic beverages decide that they don’t want to pay the extra excise tax and, as a result, stop drinking alcoholic beverages? If this happens, where will the government get the money needed to transform the mental health system? In other words, does the Canadian government have a realistic “plan B” for this major transformation?

A Logical Contradiction

From a different perspective, isn’t it rather ironic that those who drink alcoholic beverages will pay for the revamped mental health system? Isn’t there a contradiction in logic somewhere in this proposal? Stated differently, if tens of thousands of Canadians have mental illnesses or are addicted to alcohol or drugs, wouldn’t the government want Canadians to drink LESS alcohol in order to reduce the existing alcohol abuse, alcoholism, and alcohol-related mental health problems? Yet according to the current mental health proposal, from strictly a financial standpoint, it would appear that the Canadian government is banking the entire mental health system upgrade on historical data that strongly suggests that Canadians will continue to drink at their current or even higher levels of consumption.

Budgetary Miscalculations

What happens, for instance, if there are cost overruns in the proposed mental health system? There are, of course, two “easy” solutions to this problem: increase the excise tax on each drink or motivate Canadians to drink even more alcoholic beverages. Either “solution,” however, is predicated on the fact that in order to “work,” the upgraded mental health system needs to be funded by Canadians who continue to drink alcoholic beverages.

Conclusion

It appears logical to conclude that the Canadian mental health system is in need of a major overhaul. As with most comprehensive government programs, however, the issue of funding becomes a major obstacle to overcome. The proposed Canadian mental health system upgrade is no exception. Based on the reasons given above, it seems obvious that the Canadian government needs to come up with alternate sources of revenue generation for this worthwhile project. Indeed, to point out one of the major “flaws” in the current proposal, consider the following question: When is more drinking a “good thing?” Answer: when it finances a nationwide mental health system upgrade. Something tells me that Andy Rooney from “60 Minutes” would have a lot of fun with this.

Copyright 2007 – Denny Soinski. All Rights Reserved Worldwide. Reprint Rights: You may reprint this article as long as you leave all of the links active, do not edit the article in any way, and give the author credit.

Most of us suffer from mental health problems, though in varying degrees. Although mental ill-health affects so many people, there is still no proper definition as to what mental health problems are and what methods are needed to recover. It is reported that at least 1 in 10 young people and around 1 in 4 adults experience mental health problem at some time in their lives. Mental health can mean a wide range of symptoms and disorders – like depression, anxiety, self-harm, violent tendencies, schizophrenia and various types of mania. The mental health problems can develop at any time in one’s life and each person’s experience can be unique and can last from several weeks to even a lifetime.

People suffering from mental ill-health will think, feel or behave abnormally. This can be confusing not only for them but can affect their relationships, their work or education, and their social life. Having a mental health problem can create difficulties for all family members, friends, and the people they interact with. Mental health problems are usually caused by a variety of factors including breakdown in a relationship, death of a family member or a close friend, bullying, abuse, divorce, separation from parents or loved ones, stress born of a person’s current situation. Mental health can happen suddenly without prior indications or get built up over time.

When people first begin to experience mental health difficulties they may not be able to fathom what is happening. In several instances, people tend to deny that anything is wrong with them or even suppress information. Their reasons for doing this could be embarrassment, a sense of shame or fear of other people’s reactions. There is no denying the fact that mental health results in social stigma. Please remember that there is a lot of support available to help people recover from mental health problems – in terms of counseling, therapy, medication and treatment in hospital. Different treatments are recommended for different types of mental illnesses. With the right support, the majority of people with mental health problems will surely recover.

Mental health saps your energy, hope, ambition and drive, sometimes making it difficult to do even the normal day-to-day activities. Although overcoming depression may not be quick or easy, it certainly is not impossible. Feeling completely better may take time, but you can get there if you make positive choices for yourself each day and draw on the support of your loved ones. Recovering from depression calls for positive action but taking action when you’re depressed is hard. Some simple things you need to do are physical exercise, eating right food and rating regularly, sleeping at least for six hours, going out for walks in open areas, interacting with loved ones, avoiding loneliness, refusing to think negatively etc. . You probably already know that these things will help you overcome depression but following these rules are not easy when you are depressed. This is the Catch-22 situation of depression recovery. The symptoms of depression such as fatigue, despondency, incoherent thinking, and low self-esteem make it difficult to take the necessary steps to recovery. A realistic recovery plan therefore involves taking responsibility for the choices and changes you do have control over and avoiding the things you cannot control.

All forms of mental illnesses are treatable if the patient receives competent professional care. Psychologists are among the licensed and highly trained mental health providers with years of experience studying depression and helping patients recover from it. Unfortunately, there is some social stigma associated with seeking help for emotional and mental health problems as feelings of depression often are viewed as a sign of weakness rather than as a signal that something is out of balance. Persons suffering from mental health who do not seek help suffer needlessly. Unexpressed feelings and concerns accompanied by a sense of isolation can worsen mental health. The importance of obtaining timely professional health care is the need of the only answer for mental maladies.

Dr. Stuart Eisendrath, director of the UCSF Depression Center, leads a mindfulness exercise as a technique for maintaining mental health. Series: UCSF Mini Medical School for the Public [2/2010] [Show ID: 18122]

There are many facets to the world of mental health, especially when it comes to health insurance and finding adequate coverage for a variety of afflictions and disorders. We’ve put together some answers to some of the more common questions revolving around these topics for you below.

Do most health plans include mental health coverage? The answer, simply put, is yes. The vast majority of insurers and health plans cover at least a limited amount of mental health care.

According to a recent employer survey published in the journal Health Affairs:
•91 percent of small firms (10-499 employees) and 99 percent of large firms offer mental health and substance abuse coverage in their most used medical plans.
•Mental health and substance abuse coverage was included in 87 percent of indemnity plans, 88 percent of HMOs, 97 percent of Point of Service (POS) plans and 93 percent of Preferred Provider Organizations (PPOs).

It is commonly acknowledged today, in 2006, that most employees who have employer-based health insurance have access to mental health coverage, and many of the employees who don’t have coverage have simply chosen not to join an employer’s plan that includes mental health services.

Does mental health coverage cost more? Yes, this is generally the case. There are limits to mental health coverage and the reason why most employers impose limits is due to cost. Estimates vary widely of how much more mental health coverage costs. Here are some results from some studies:

•A 1998 study sponsored by National Advisory Mental Health Council (NAMHC) Parity Workgroup, a division of the federal National Institute of Mental Health, estimated that mental health services would add less than 1 percent to the cost of a health insurance policy for an HMO.

•A 1998 study by Mathematica estimated a 3.6 percent increase across all plans, with a range of 0.6 percent increase for HMOs up to a 5 percent increase for fee-for-service plans.

•A 1997 analysis by the actuarial firm Milliman & Robertson for the National Center for Policy Analysis, examining the cost of a typical mental health mandate (not specific legislation), concluded that mental health services parity legislation tends to drive up costs by 5 percent to 10 percent.

With regard to mental insurance in general, how do insurance companies treat mental illness? Insurance companies tend to be somewhat wary of mental health claims due to the increase of fraudulent claims. When Medicare looked for fraud in the community mental health centers last year, it barred 80 of them in nine states from participating in the program.

The Health Care Financing Administration (HCFA), which administers Medicare, knew something was amiss when the average yearly cost for each senior getting mental health services jumped from $1,642 in 1993 to more than $10,000 by 1997.

Medicare administrator Nancy-Ann DeParle contended at the time that 90 percent of the patients had no mental illness serious enough to qualify for special treatment.

That being said, it’s straightforward to understand why there is trepidation on the part of health insurance providers.

What mental conditions are typically covered, and not covered by health plans? Generally speaking, a health plan pays for only those services included in the plan’s list of covered services. In the case of mental health services, inpatient and outpatient treatment are most often covered by health plans.

However, there is a continuum of services between inpatient (mental health clinic) and outpatient care that effectively treat many mental disorders and are often more cost-effective than inpatient care at a mental health clinic.

These intermediate services include nonhospital residential services, partial hospitalization services, and intensive outpatient services such as case management and psychosocial rehabilitation. Psychosocial rehabilitation includes pharmacologic treatment, social skills training, and vocational rehabilitation.

Such services are covered by approximately half of employer-sponsored health plans.
Prescriptions. Are they covered? Coverage of prescription medications is also important in providing access to treatment for mental health disorders. And, on a positive note, Prescription medications are nearly always covered by health plans (U.S. Department of Labor, 1996; 1998), but this coverage is sometimes limited by formulary restrictions.

Check with your healthcare provider for the exact details on what applies to you and your family with regard to your specific circumstances.

Why Pursue Mental Health Integration?

It is the right thing to do: The NCCBH vision statement provides the foundation for our work: We are committed to creating and sustaining healthy and secure communities, achieved through a system that holds the needs of consumers paramount, regardless of their ability to pay.

Vital to this commitment is a network of organizations and advocates promoting services of unparalleled value.

NCCBH members primarily serve public sector consumers, those with severe and persistent mental illness or serious emotional disturbance-the needs of this population are often overlooked in primary care and integration planning. We must assure that their needs as well as the needs of the broader community are appropriately addressed.

Many people in the broader community now receive their behavioral healthcare in a primary care setting, and the gap between the medical and behavioral healthcare systems must be bridged: As noted by Robin Dea and many other commentators, there is:

“evidence that many, if not most, people coming into primary care are being treated for psychosocial problems, not organically based medical disease . . . evidence of medical cost offsets from treating behavioral health problems presenting as physical health problems in the primary care setting . . . the assumption that if adequate detection of early stage psychiatric illness took place in primary care, there would be some prevention of patients going to more severe episodes of major psychiatric illnesses . . . and primary care is where most people who have behavioral health problems are in fact seen.”

Some of the important findings from the research field include:

-The Epidemiologic Catchment Area (ECA) Study and articles based on this survey data, reported the finding that about 50% of care for common mental disorders was delivered in general medical settings. However, many subsequent studies have shown that these disorders may be undiagnosed or under-treated.
-Screening systems, treatment guidelines and provider education in primary care are necessary but not sufficient steps to ensure a difference in outcomes.
-Collaborative and stepped care has been shown to achieve outcomes that are better than “usual care”.

There is the opportunity for quality improvement of care within the primary care and specialty behavioral healthcare settings: Studies have shown that many people with depression stop taking their medications before the minimal time required to effectively treat an episode of depression. Patients at Group Health Cooperative who initiated medications for depression with their primary care physician and received targeted stepped up care and relapse prevention support were significantly more likely to adhere to adequate dosages of medication and to demonstrate a greater decrease in depressive symptoms.

Application of research findings such as these through adoption of evidence-based practices in both primary care and specialty behavioral health (BH) settings will result in better outcomes for consumers.

With the publication of Priority Areas for National Action: Transforming Health Care Quality, the Institute of Medicine’s 2003 follow up to Crossing the Quality Chasm: A New Health System for the 21st Century, a major opportunity and challenge has appeared for the public mental health system.

The Quality Chasm recommended the systematic identification of priority areas for national quality improvement; Priority Areas proposes twenty areas for transforming health care nationally. Included in this list are major depression (screening and treatment) and severe and persistent mental illness (focus on treatment in the public sector).

Their inclusion as priority areas, as well as the findings in the Interim Report from the President’s New Freedom Commission on Mental Health, with its observation that the system is “fragmented and in disarray-not from lack of commitment and skill of those who deliver care, but from underlying structural, financing and organizational problems” suggests that the time for new strategies is at hand.

Many people being served by public behavioral health services need better access to primary care: A rationale less frequently articulated for integration is that the specialty BH system, especially the public sector focusing on the severe and persistent mentally ill adult population (SPMI) and seriously emotionally disturbed (SED) children, serves a disabled consumer population with healthcare needs that are frequently under-addressed due to difficulties in obtaining medical services.

Most state Medicaid waivers related to coverage for physical healthcare have focused on enrollment of the TANF population into Medicaid managed care plans, leaving the disabled Medicaid population unable to adequately access care, or in better situations, reliant on “safety net” providers-community health centers (CHCs) or county delivered health services.

Community health centers serve people who need better access to behavioral healthcare. These “safety net” providers serve a broader scope of patients than just the Medicaid population. But many states have implemented mental health Medicaid waivers that focus the public mental health system on the SPMI/SED and Medicaid populations, with minimal levels of support for non-SPMI/SED or uninsured populations. Often there is not a good match of target populations between the two systems. If the Medicaid mental health program also has a highly managed service authorization and payment methodology, there may be additional barriers to reimbursement for mental health services.

This has led to frustration for “safety net” healthcare providers because they have difficulty obtaining behavioral health services for their non-SPMI/SED or uninsured patients. In a recent survey of CHC medical directors, 80% indicated that cost is the main barrier to behavioral health care for their uninsured populations. The recent financing and development of behavioral health services in CHCs addresses this frustration and is just the latest in a series of efforts to acknowledge that a large proportion of the population gets their behavioral health services in primary care.

Because behavioral health clinicians are a resource for assisting people with all types of chronic health conditions: Yet another reason for integration is the potential contribution of BH clinicians regarding behavioral and lifestyle change: providing interventions targeted at better management of chronic disease, supporting and “leveraging” the time of primary care providers through disease management programs.

Disease management activities focus on several areas: early identification of populations at-risk for costly chronic disease (e.g., asthma, diabetes), care interventions that utilize evidence-based practices, education-intensive orientations that focus on both patient and provider, care management and a coordinated approach across multidisciplinary treatment teams, and a method for systematic data collection that measures clinical and cost-effectiveness. Large organized healthcare systems, such as Northern California Kaiser-Permanente, implement their major disease management programs with specifically assigned nurses as care managers and educators.

However, many physicians in individual or group practices do not have access to this level of support unless they are in the network of a health plan with active disease management programs. In markets where primary care and multi-specialty groups have accepted accelerated risk, disease management approaches will be especially value-added.

We are in a time of significant public policy activity regarding financing of the national healthcare system and the uninsured population. As we approach the 40th anniversary of the founding of the community mental health center movement, the dialogue has returned us to our public health beginnings-serving the needs of a population.

The Health Resources and Services Administration (HRSA) Primary Care Integration Initiative is currently being implemented across the country. The HRSA initiative includes: identification of system issues related to integration and the development of related strategies; development of a service manual for CHC behavioral health services; development of BH intervention models for CHCs; and grants for establishing BH services in existing CHCs.

Newly funded CHC sites will be expected to provide dental, mental health and substance abuse services, either directly or by subcontract arrangements. CHCs are in the process of decision making about building their own BH services or contracting for BH services, as they prepare their grant applications. (The NCCBH website, www.nccbh.org, has a Primary Care Integration Resource Center with more details about the HRSA process.)

At the same time that HRSA is putting new BH resources into CHCs, reports are emerging from many states indicating that the public mental health system is funded at somewhere around half the level that is needed. In the private sector, the relentless downward pressure on behavioral health PMPMs has also reduced overall system resources, shifting cost from the private sector to the public sector.

Reports such as these were released prior to the current fiscal crisis in state Medicaid programs; rather than addressing the shortfalls, there are significant new reductions in BH services in many states. And, the implementation of managed care methods for Medicaid have made it difficult for some community based BH providers to continue to enact their mission of serving the needs of the population, regardless of ability to pay.

The implications for system-wide duplication and competition for the scarce resources of BH staff and funding, as well as the opportunity to improve consumer access to both health and behavioral healthcare services, suggests that collaboration is a priority at the national, state and local levels. Good public policy will work at sustaining, supporting and requiring collaboration between the two “safety net” systems of community mental health centers and community health centers.

The conceptual model proposed in this paper can become the basis for HRSA grantees to work with their partners in the public mental health system to fully define working relationships and collaboration on behalf of consumers of care.

In summary, the reasons for integration are grounded in the desire to improve access to both primary care and behavioral health services; ensure that there are evidence-based practices as well as consistent communication and coordination of clinical activities (especially medication management-a key concern of consumers) among the providers serving any single individual; wed the skill sets of primary care physicians and BH clinicians in order to better manage chronic health issues; and, participate in and shape the public policy debate regarding how services should be organized, delivered and financed in ways that ensure that needs of public sector SPMI/SED consumers and the broader community alike are met.

Be My Friend – www.myspace.com The Truth about Mental Disorders. Dr. John Breeding, Ph.D. psychologist discusses how mental disorders are created by the American Psychiatric Association and listed in the DSM (Diagnostic and Statistical manual of Mental Disorders. Disorders such as bipolar, ADHD, OCD, Anxiety Disorders, etc. are voted into existence by APA committees. The underlying assumption of biological psychiatry is that mental illness is biologically based despite the fact that no solid science has been able to identify biological markers for mental illnesses. Visit Dr. Breedings Website at www.wildestcolts.com This video was produced by Psychetruth http www.myspace.com Copyright ©CAEST 2007. All Rights Reserved. This video maybe displayed in public, copied and redistributed for any strictly non-commercial use in its entire unedited form. Alteration or commercial use is strictly prohibited.

Be My Friend – www.myspace.com Nutrition by Natalie Nutrition and Your Mental Health What does nutrition have to do with mental health? You might be surprised to find out the truth behind what happens when a person has a nutritional deficiency. Nutritional deficiencies can cause all sorts of psychiatric symptoms including apathy, low energy, irritability, insomnia, low energy, agitation, fatigue, concentration problems, aches and pains, weight changes, including weight loss or weight gain. Sound a lot like the symptoms of depression? The truth is the average American diet of fast food is low in vital nutrition that you need for your body to function correctly. This isn’t to say that all depression is caused by bad nutrition but it’s certainly a contributing factor in many cases and poor nutrition will always make depression worse. Antidepressant drugs also do not correct nutritional problems. So if your depressed because of nutritional problems an antidepressant will only partially cover up the problem and you body still won’t function correctly. Please visit Natalie’s website at www.nutritionbynatalie.com To find out more about orthomolecular psychiatry visit, http This video was produced by Psychetruth www.myspace.com www.youtube.com www.livevideo.com ©Copyright 2007 Zoe Sofia. All Rights Reserved. This video maybe displayed in public, copied and redistributed for any strictly non-commercial use in its entire unedited form. Alteration or commercial use is strictly …