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Public Health Model for Mental Health


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Based on the report from the Washington State Board of Health, this presentation, made to the State
and King County Boards of Health on December 13, 2007, suggests a public health model for approaching delivery
of mental health services.

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Public Health Model for Mental Health

  1. 1. A Public Health Model for Mental Health Craig McLaughlin, Executive Director Wendy Janis, Policy Advisor Washington State Board of Health Mental Health Transformation/TWG, Olympia, WA, 2008
  2. 2. <ul><li>Prevention Advisory Group (PAG) </li></ul><ul><li>Ad hoc work group of MHTP </li></ul><ul><li>Diverse participants (DSHS, SBOH, DOH, UW, providers, OSPI, FPC, Children’s Trust, nonprofits, consumers) </li></ul><ul><li>Debated what is meant by prevention </li></ul><ul><li>Identified specific populations (lifespan) </li></ul><ul><li>Developed multi-stage approach </li></ul>
  3. 3. <ul><li>PAG Definition of Prevention </li></ul><ul><li>Promotes mental health, intervenes early to address emerging mental health problems, and reduces the devastating impacts of mental illness </li></ul>
  4. 4. Multi-Step Process (to date) <ul><li>TWG Presentation (April 27, 2007): TWG agrees work is consistent with its goals </li></ul><ul><li>First Prevention Day (July 13, 2007) : Consumers, providers, and agency staff help frame report and begin policy discussions </li></ul><ul><li>Focus Groups (Sept./Oct.): Policy discussions about specific populations--also received feedback through questionnaires </li></ul>
  5. 5. Multi-Step Process (to date) <ul><li>Partial Report Draft (Nov. 2) </li></ul><ul><li>Second Prevention Work Day (Nov. 9) Synthesize material in report, look at cross-cutting themes, and set policy priorities </li></ul><ul><li>Report Draft Approved by Board (Dec. 13) </li></ul><ul><li>Board Staff Delivered Final Report to MHTP (Dec. 31) </li></ul>
  6. 6. <ul><li>Part I: Mental Health and The Public Health Model </li></ul><ul><ul><ul><li>Prevalence of mental illness/its impact </li></ul></ul></ul><ul><ul><ul><li>The grant and SBOH involvement </li></ul></ul></ul><ul><ul><ul><li>Public health model for mental health </li></ul></ul></ul><ul><ul><ul><li>What is meant by prevention </li></ul></ul></ul><ul><ul><ul><li>Disparities in mental health </li></ul></ul></ul><ul><ul><ul><li>Whether mental illness preventable </li></ul></ul></ul><ul><ul><ul><li>Barriers to prevention </li></ul></ul></ul>
  7. 7. Part II: Age-Specific Groups <ul><li>Children birth to five </li></ul><ul><li>School-age children </li></ul><ul><li>Youth in transition to adulthood </li></ul><ul><li>Adults </li></ul><ul><li>Older adults </li></ul>
  8. 8. <ul><li>Children Birth to Five </li></ul><ul><ul><ul><li>Age-Specific Characteristics </li></ul></ul></ul><ul><ul><ul><li>Infants and toddlers have mental health needs and disorders </li></ul></ul></ul><ul><ul><ul><li>Mental health is relationship-based </li></ul></ul></ul><ul><ul><ul><li>Social-emotional skills are critical </li></ul></ul></ul><ul><ul><ul><li>Diagnosis and treatment is possible but requires specialization </li></ul></ul></ul>
  9. 9. <ul><li>Children Birth to Five </li></ul><ul><ul><ul><li>Suggested Next Steps </li></ul></ul></ul><ul><ul><ul><li>Social marketing campaign </li></ul></ul></ul><ul><ul><ul><li>State-wide mental health consultation for child care providers </li></ul></ul></ul><ul><ul><ul><li>Medical provider screening/referral </li></ul></ul></ul><ul><ul><ul><li>Collaboration between various agencies and providers </li></ul></ul></ul><ul><ul><ul><li>Opt to serve and fund services to at-risk children under Part C </li></ul></ul></ul>
  10. 10. <ul><li>School-Age Children </li></ul><ul><ul><ul><li>Age-Specific Characteristics </li></ul></ul></ul><ul><ul><ul><li>Do experience mental illness--HYS </li></ul></ul></ul><ul><ul><ul><li>Work is being done to identify risk and protective factors </li></ul></ul></ul>
  11. 11. <ul><li>School-Age Children </li></ul><ul><ul><ul><li>Suggested Next Steps </li></ul></ul></ul><ul><ul><ul><li>Research risk and protective factors </li></ul></ul></ul><ul><ul><ul><li>Expand program evaluation and wide dispersal of evaluation results </li></ul></ul></ul><ul><ul><ul><li>Educate parents and educators </li></ul></ul></ul><ul><ul><ul><li>Train physicians for screening and referral </li></ul></ul></ul><ul><ul><ul><li>Provide more support for families and youth </li></ul></ul></ul><ul><ul><ul><li>Coordinate/integrate mental health services and screening with schools </li></ul></ul></ul>
  12. 12. <ul><li>Youth in Transition to Adulthood </li></ul><ul><ul><ul><li>Age-Specific Characteristics </li></ul></ul></ul><ul><ul><ul><li>Neither the child nor adult mental health system provides appropriate services </li></ul></ul></ul><ul><ul><ul><li>Almost no system has ownership of this group </li></ul></ul></ul><ul><ul><ul><li>Lack of health coverage </li></ul></ul></ul><ul><ul><ul><li>Mental illness often arises during this time </li></ul></ul></ul>
  13. 13. <ul><li>Youth in Transition to Adulthood </li></ul><ul><ul><ul><li>Suggested Next Steps </li></ul></ul></ul><ul><ul><ul><li>System with no wrong door for services </li></ul></ul></ul><ul><ul><ul><li>Drop-in center model with peer support </li></ul></ul></ul><ul><ul><ul><li>Social marketing campaign for stigma </li></ul></ul></ul><ul><ul><ul><li>From the Literature </li></ul></ul></ul><ul><ul><ul><li>Provide appropriate services within child and adult systems and continuity between them </li></ul></ul></ul><ul><ul><ul><li>Implement transition support programs </li></ul></ul></ul>
  14. 14. <ul><li>Adults </li></ul><ul><ul><ul><li>Age-Specific Characteristics </li></ul></ul></ul><ul><ul><ul><li>The mental health system appears to be adequately focused on adults in terms of their age-specific needs </li></ul></ul></ul>
  15. 15. <ul><li>Adults </li></ul><ul><ul><ul><li>Suggested Next Steps </li></ul></ul></ul><ul><ul><ul><li>Provide more transitional services </li></ul></ul></ul><ul><ul><ul><li>Move from diagnosis-based access to need-based access </li></ul></ul></ul><ul><ul><ul><li>Continue to move the mental health system to a recovery model </li></ul></ul></ul><ul><ul><ul><li>From the Board Staff </li></ul></ul></ul><ul><ul><ul><li>Offer more intensive services at an initial crises rather than having chronic or multiple crises episodes be criteria for access </li></ul></ul></ul>
  16. 16. <ul><li>Older Adults </li></ul><ul><ul><ul><li>Age-Specific Characteristics </li></ul></ul></ul><ul><ul><ul><li>Conditions such as depression and anxiety are not a normal part of aging </li></ul></ul></ul><ul><ul><ul><li>Treatable mental disorders increase disability </li></ul></ul></ul><ul><ul><ul><li>Older adults strongly prefer to see only primary care physicians due to stigma </li></ul></ul></ul><ul><ul><ul><li>Some older adults are isolated in their homes </li></ul></ul></ul>
  17. 17. <ul><li>Older Adults </li></ul><ul><ul><ul><li>Suggested Next Steps </li></ul></ul></ul><ul><ul><ul><li>Social marketing campaign stigma/education </li></ul></ul></ul><ul><ul><ul><li>Increase outreach to get older adults into care </li></ul></ul></ul><ul><ul><ul><li>From the Literature </li></ul></ul></ul><ul><ul><ul><li>Integrate geriatric psychiatry into primary care </li></ul></ul></ul><ul><ul><ul><li>Increase support for family caregivers </li></ul></ul></ul>
  18. 18. Part III: Integration <ul><li>Cross-cutting themes </li></ul><ul><li>Coordination & communication </li></ul><ul><li>Prioritizing prevention investments </li></ul>
  19. 19. Cross-Cutting Themes <ul><li>Communication and coordination </li></ul><ul><li>Social marketing </li></ul><ul><li>Increase funding flexibility </li></ul><ul><li>Leverage existing funding sources </li></ul><ul><li>Assess risk and protective factors </li></ul><ul><li>Screen at multiple points of entry </li></ul><ul><li>Provide care based on need </li></ul>
  20. 20. Cross-Cutting Themes (cont.) <ul><li>Provide age-appropriate services </li></ul><ul><li>Provide culturally competent services </li></ul><ul><li>Meet people where they are </li></ul><ul><li>Support transitions across the lifespan </li></ul><ul><li>Provide mental health consultation </li></ul><ul><li>Increase and improve provider training </li></ul><ul><li>Create trauma-sensitive systems </li></ul>
  21. 21. Coordination & Communication <ul><li>Leadership and governance </li></ul><ul><li>Shared-outcomes </li></ul><ul><li>State-wide accountability </li></ul><ul><li>Local flexibility </li></ul><ul><li>Shared data and analysis </li></ul>
  22. 22. Coordination & Communication (examples) <ul><li>Public Health System </li></ul><ul><li>Family Policy Council </li></ul><ul><li>Children’s Trust of Washington </li></ul><ul><li>Division of Alcohol & Substance Abuse </li></ul><ul><li>Superintendent of Public Instruction </li></ul><ul><li>Governor’s Council on Substance Abuse </li></ul>
  23. 23. Prioritizing Prevention Investments <ul><li>Build on current successes </li></ul><ul><li>Transformative </li></ul><ul><li>-consumer input & peer-support components </li></ul><ul><li>-multidisciplinary </li></ul><ul><li>-science-based </li></ul><ul><li>Sustainable </li></ul>
  24. 24. Next Steps <ul><li>MHTP hosts community forums </li></ul><ul><li>(early 2008) </li></ul><ul><li>Policy summit (May 13, 2008) </li></ul>
  25. 25. Washington State Board of Health PO Box 47990 Tumwater, Washington 98504-7990 (360) 236-4106, Fax (360) 236-4088