Wednesday, April 30, 2008

Budgets can be Exciting: Saving MCPAP

A funny thing happened on the way the budget the other day- when the budget came out of the House Ways and Means Committee, the section that specified funding for the MCPAP program, of which we have spoken with great praise, was missing. Just vanished, from the end of a paragraph that had passed through the process unscathed on several occasions in the past. In the words of my son, "What's up with that?"

The answer, I guess, is that we will never know. Budgets are created in committee, and they are very large. The committee staff work in a pressure cooker for a month, adding the numbers, trimming to fit, and they don't always know what they are trimming. I've asked a lot of smart people what happened, and no one seems to know.

The process gets even more chaotic at that time; the representatives are allowed to file amendments for about 48 hours, and then it all goes back into caucus, where the amendments are consolodated and voted on in a block. More sleepless nights for the staffers and much nail-biting for advocates. Ruth Balzer filed an ammendment to save MCPAP and it was included in the consolodated amendment that was voted on on Tuesday.

So the good news is that, at the end of the day, MCPAP was back in the budget that will soon be on its way to the Senate. It really shows the importance of participating in all of this complex and marvelous process that is our democracy. Thanks to all of you who joined in the chorus of praise that kept it all alive.

Tuesday, April 29, 2008

A Clutch of Commissioners: Talking Mental Health at the Mass Chapter of the AAP

Walter Harrison has a quiet persistence that raises him head and shoulders above many of those in the "mental health advocacy" business.  I've been meaning to write about it, but it has just been too busy...
The Mental Health Task Force of the Massachusetts Chapter of the AAP has been chaired for many years by Walter Harrison, a private practice pediatrician who has done more than most of us to shape the practice of pediatrics in the Commonwealth.  He specializes in redefining problems that seem intractable in to bite-size nuggets that have solutions, and then convening the groups needed to solve the problem.  He is really good at what he does;  he has gotten health plans to talk to hospitals and advocates to talk to doctors.  Earlier this month, he got the Commissioners of the 5 Agencies that deal with Children's Mental Health and Emily Sherwood of the CBHII into one room to talk about Rosie D and the changes that are a-coming.   It was an extraordinarily enlightening experience.
First, the panel:  Barbara Leadholm [Commissioner, Dept of Mental Health],  John Auerbach [Commissioner, Dept of Public Health],  Angelo McClain [Commissioner, Dept of Social Services],  Jane Tewksbury [Commissioner, Dept of Youth Services]
Suzanne *missed her last name* (substituting for Tom Dehner [Medicaid Director, Division of Medical Assistance]) and Emily Sherwood [Children's Behavioral Health Interagency Initiative].  It was a high level group of people that Walter brought together- all leaders in their field.  They clearly know how complicated this is all going to be;  all of them see the need to change, and to engage in more collaboration throughout the Commonwealth.  The RFR was one way in which the group was seeking input;  78 people, advocates and agencies answered the call.  (Many of you watched me work through it in realtime last month).  They are also in the middle of pulling together a Children’s Behavioral Health Advisory Council of about 50 people to offer advice and feedback as the process evolves.  All of the leadership clearly stated the need to more inclusive and family centered in the implementation of this novel agreement.
Emily Sherwood began with an update on implementation status:
  • Screening: Screening went into effect on 1 January. Trainings have happened throughout the state, and there seems to be little problem so far. Primary care providers are using the designated intruments, and finding some problems.  MCPAP is supporting this effort through both clinical support and practice management support.
  • RFI: The information obtained in the RFI process is being collated, and will be examined by two work groups are working to looking at the implications for “MassHealth” and for other“Interagency” changes.
  • Assessment: On 11/30/08, the CANS instrument goes into effect. UMASS is in the process of organizing and performing the trainings. They plan to train 6000 clinicians all across the state. They have recognized the need to change the Wway that information is gathered at a structural  level.
  • Services: The RFR for CSAs comes out in June. Then it gets interesting....
  • Also, changes in the data system are happening.
Finally, there are workforce issues: they have met with Deans of the Schools of Social Work, to begin building the training programs that will be necessary going forward.  The Deans acknowledge the need to change the curriculum to match the wraparound component, and they are planning a Conference in November. They envision some sort of “wraparound” leadership academy for care managers and lead family partners. 
They ended with a thought:  Secretary Bigby sees this as one big sandbox. The agencies need to play together.

The members of the Task Force raised good questions:
  • Screening: The AAP recommendations at 9, 18 and 30 months.  Why do we need to screen children so often?
Clearly, the process is constrained by judicial involvement.  There will be more discussion of this.
  • Evaluation:  The CANS is the “culmination document”. No place in the database for psychological or neuropsychological data- more quantitative data is not in the plan.
Acknowledged.  The CANS is flexible;  we will have to see how flexible as we go forward.
  • Coordination:  We have, under various guises, tried a variety of ways to encourage interagency cooperation.  It's hard.  What will be different this time?  And, in the meantime, what do families do who are struggling?  
Our prior experience suggests that rigid prescription is not the right way:  One family, one plan with “only enough structure” to make it work." seems the best move.

There was more, but you get the flavor of it.  Even I got to ask a question, although I am afraid it was a bit garbled.  My apologies to the chiefs.   This was a group of good people committed to the welfare of children, working through the details.  Good to see. 

Thanks, Walter.

Monday, April 28, 2008

What's to be done: A discussion at Common Pathways

Common Pathways is a Worcester-based group of folks that serves Worcester as the Community Health Network (CHN) of Worcester City, that is trying to establish benchmarks and a pathway to the creation of a Healthy  City in Worcester.  Last Thursday night, I participated in a discussion of the mental health needs of the City of Worcester, based on a set of indicators that have collected over the past few years.  It was interesting:  it is hard to find indicators of mental health status in the data currently collected within the Commonwealth, and the one's identified so far are mostly measures of service delivery (number of Emergency Mental Health visits, for example) rather than outcome (such as rates of "mentally healthy children" in the various neighborhoods of Worcester).  We don't even have data on the prevalence of different diagnoses within the city, which makes it hard to look at our ability to meet the need-  we don't know the need that we need to address.  The indicators selected seemed to reflect people and families in crisis;  in addition the EMH visits, we had hospitalizations for substance abuse, drugs of choice for those in substance abuse treatment and the needs expressed in the Latino mental health survey.  All seemed to represent the end of journey, the sort of care that is provided after prevention and early intervention has failed.
Nonetheless,  our group took notice of the many bright spots regarding mental health treatment in Worcester over the past few years:  the HOPE coalition's efforts to integrate youth services and mental health care,  the Together for Kids program that has helped daycare and preschool program implement strategies to manage out of control children without expulsion and the Latino Mental Health Project which has promoted dialogue on differing perceptions of mental health within our community and Communities of Care,  our own answer to the Wraparound World .  Our task, however, was to try to come up with an idea or project that could be championed through Common Pathways that would likely affect the indicators that had been selected.  We came up with 2 ideas:
1)  Sell mental health to the people:  There is a huge amount of stigma associated with mental health diagnoses and patients in general don't like to talk about it.  Our group felt that this led to deferral of treatment and ultimately poor treatment.  We should develop a citywide marketing campaign that makes it OK to talk about mental illness, so that families wouldn't "put off" seeking care.
2)  Help break down the silos:  Often, the right hand knoweth not what the left hand is doing;  that is true within agencies and between agencies.  We discussed a souped up "211" line and other options for getting the word out about what different agencies can make happen making services more available to more people.
We were supposed to come up with one big project for our working group, so we sort of merged them and figured that the powers would make it all work.  Might be a bit much.  Our recommendations went the full committee for consideration and will likely make it out to the website later this month.
Getting late, and I must sleep.

Wednesday, April 23, 2008

Getting on with the Act: More Legislation on Children's Mental Health

It has been busy lately, with meetings, lobbying and small children in the exam rooms. Much going on.  This from Health Care for All:

Save The Date: Tuesday, May 6
CMHC Bill Naming Event
Please reserve 10:30 a.m., Tuesday, May 6 for an important Children's Mental Health Campaign event in State House in room 222.  The Children's Mental Health Campaign is holding a press conference to announce that SB 2518, An Act Relative to Children's Mental Health, will be known as "Yolanda's Law." 
Last May, Yolanda Torres and her mother Mary Ann Tufts traveled from Plymouth to testify before the Joint Committee on Mental Health and Substance Abuse in support of the Children's Mental Health Bill.  Yolanda, an articulate and creative 15 year old, shared her experiences with the children's mental health system and her personal battle with mental illness.
Yolanda wanted to change the system of mental health care so that others would not have to go through what she had been through.  She considered her advocacy that day in the State House to be one of the most important experiences in her life. 
Tragically, Yolanda died on January 28, 2008.
At the request of Yolanda's family and in consultation with members of the Legislature who have been leaders on this issue, An Act Relative to Children's Mental Health, will now be known as Yolanda's Law. 
Please join us on May 6 to support Yolanda and her family, to support the passage of the legislation, and to support the Children's Mental Health Campaign. 
All are welcome to attend.  Mary Ann Tufts, her husband and close friends are planning to attend and speak about Yolanda. Please forward this message on to your networks and ask them to join us on May 6. 

Restore Funding for MCPAP
On Wednesday this week, the House Ways and Means Committee released its FY 2009 budget.  In this budget, funding for the Massachusetts Child Psychiatric Access Project (MCPAP) was eliminated.    MCPAP is a valuable program that provides mental health consultative services to pediatricians.  An important provision in SB 2518, An Act Relative to Children's Mental Health, would expand MCPAP to schools.
Representative Ruth Balser has filed an amendment that would restore the $2.5 million this program needs to line item 5042-5000.  The text of the amendment is available here. 
Please encourage your networks to call their legislators and ask them to support Representative Balser's amendment. 

Friday, April 18, 2008

Guest Spot: Childrens' Mental Health

Children's Mental Health Coalition Introduces Bill of Rights for Families Living With Mental Illnesses

Washington, D.C., April 15, 2008 -- The children's mental health coalition has created a Bill of Rights for Children with Mental Health Disorders and their Families. The coalition includes the American Academy of Child and Adolescent Psychiatry (AACAP), the Autism Society of America (ASA), the Child and Adolescent Bipolar Foundation (CABF), Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD), the Federation of Families for Children's Mental Health (FFCMH), Mental Health America (MHA), and the National Alliance on Mental Illness (NAMI).

"This Bill of Rights represents the standard of what families living with mental illnesses should expect from treatment," said AACAP's President, Robert Hendren, D.O. "Children do better when they receive consistent, tailored treatment. Few children receive any treatment and fewer still receive the sustained, quality care that they require."
The Bill of Rights was created because of the inconsistency of accessible mental healthcare services throughout the country.
The Bill of Rights: 1. Treatment must be family- driven and child-focused. Families and youth, (when appropriate), must have a primary decision-making role in their treatment.

2. Children should receive care in home and community-based settings as close to home as possible.

3. Mental health services are an integral part of a child's overall healthcare. Insurance companies must not discriminate against children with mental illnesses by imposing financial burdens and barriers to treatment, such as differential deductibles, co-pays, annual or lifetime caps, or arbitrary limits on access to medically necessary inpatient and/or outpatient services.
Comment: Bravo! 20-24 sessions a year are not enough.

4. Children should receive care from highly- qualified professionals who are acting in the
best interest of the child and family, with appropriate informed consent.

5. Parents and children are entitled to as much information as possible about the risks and benefits of all treatment options, including anticipated outcomes.

6. Children receiving medications for mental disorders should be monitored appropriately to optimize the benefit and reduce any risks or potential side effects which may be associated with such treatments.

7. Children and their families should have access to a comprehensive continuum of care, based on their needs, including a full range of psychosocial, behavioral, pharmacological, and educational services, regardless of the cost.
Comment: Yes, valid research on how medications work by the literature and not by "high pressure" tactics and gifts by drug companies to prescribers.

8. Children should receive treatment within a coordinated system of care where all agencies (e.g., health, mental health, child welfare, juvenile justice, and schools, etc.) delivering services work together to support recovery and optimize treatment outcome.
Comment: What do we do about those parents who abuse substances and/or have psychiatric isssues and are allowed to have their children back and/or those who walk out of the hospitals with their babies? What about parent pre-screening for these issues like adoptive parents have to go through?

9. Children and families are entitled to an increased investment in high-quality research on the origin, diagnosis, and treatment of childhood disorders.

10. Children and families need and deserve access to mental health professionals with appropriate training and experience. Primary care professionals providing mental health services must have access to consultation and referral resources from qualified mental health professionals.
Comment: Who will pay for these consultations?

Robbin Miller
Advocate/private practitioner

Wednesday, April 16, 2008

An Act Relevant to Children's Mental Health: Do we have the Ways and Means?

Another gorgeous spring day, but today, faithful reader, I am forcing myself to stay inside and blog (I just can't see the screen in the sun, and I get distracted by bicycles and the like if I go outside). So, over the last few weeks, I have met with a number of folks at the State House about S.2518 (I wrote about this last month). So what's happened since then?

The bill is under consideration by the Senate Ways and Means Committee, who are, appropriately, trying to decide if the Commonwealth can afford this legislation. The legislation does essentially 5 things:
• Create a system so that school personnel will be able to receive mental health consultation and guidance.
• Requires insurance companies to pay mental health professionals for the time they spend on “collateral services,” or coordination of care with other important adults in a child’s life.
• Promotes behavioral health screening for children during visits to their doctors.
• Encourages behavioral health screening for very young children in childcare and preschool settings.
• Processes to move children with mental health needs to a community based or residential program.

The insurance industry, as one might suspect, is against the bill because of the "unfunded" mandate. Otherwise, the only fight is over the cost, because, as you know, this year in Massachusetts has a tight budget. I am not a budget expert; I've met budget experts and I have tremendous respect for what they do. There is, however, one flaw in the "cost-benefit" analysis process that makes this difficult. We don't know how to measure the cost of not treating children with mental illness. And, when the state is figuring out the cost savings, there are factors that they need to consider:
1) Early vs. late treatment: We know that an ounce of prevention is worth a pound of cure, yet we are so often reluctant to pay for that ounce. We have data supporting early intervention in many forms; surely there is benefit to making is easy and stigma-free to access mental health services. School consultation, child care screening, office-based screening all affect that.
2) Evidence-based treatment: Many plans restrict mental health treatment to a certain number of visits on the notion that the "evidence" doesn't support the treatment planned. While we want medical practice to be based on the evidence, the Ways and Means folks should remember that "lack of evidence" often means "no one has done the study". In mental health, for example, medications are assessed in randomized controlled trials supported by PHARMA; other forms of treatment get less study because there are fewer large funders interested in studying them. The precepts of evidence-based medicine are clear on this point: when the study hasn't been done, don't ignore the practical experience of excellent clinicians. Sometimes, by being too restrictive in the short run, we cost ourselves more in the long run.
3) Cost-shifting: I have had patients who have told me that they are trying to shift their child's insurance from their private plan to Medicaid, because the mental benefits on Medicaid are better than those in the private plan. As the state moves forward in the implementation of the Rosie D. case, the benefit of MassHealth will increase; without requiring the private insurance companies to cover community-based services and care-coordination services, there will be a tremendous incentive for payers and parents to "cost-shift" to optimize their child's care. Without this bill, the Commonwealth will be left holding the bill.
4) Economies of scale: DSS, DYS, DMH, DPH (Substance abuse), DOE- all of this gemisch of alphabetically defined agencies work on the same kids at various times. This legislation requires the kind of interdepartmental collaboration that Secretary Bigby has called for; through better collaboration, there will be some savings, but more importantly, there will be better care. Our children deserve a structure that is integrated and focused on their best interest. If that costs a little more, I'm OK with that.

It will be really hard to measure these cost-savings. Sometimes action requires people to understand the broad impact of a plan while allowing the details to sort themselves out later. And, for children's mental health, the time is NOW.

Friday, April 11, 2008

Where Have I Been?: Back in the land of Primary Care

Oddly, I have posted nothing in the last three days, and the rate of "hits" the site has gone up (from 9/day to 10/day, which is either an 11% increase or completely insignificant). What happened, you may ask. Spring. I rode 42 miles on Wednesday, and saw patients on Thursday and Friday. Lots of pretty complicated patients. So, how does it look from the world of primary care, you may ask? I guess I am an optimist: the state of America's children was looking pretty good.
My favorites are always the readers- I do have a number of them in my practice. Harry Potter has passed, now- got into a long discussion with a 13 year old about the Dark Material's series of Phillip Pullman. He liked the movie, but preferred the book. Even my "non-reader" clientele, however, are fun to get to know. Babies who eat their books are also fun. Most of my patients over the past few days seemed relatively stable, which was nice to hear.
Many, however, were trying to access the system (none with any degree of success). One saw a neuropsychologist this week, which I see as a major accomplishment. The neuropsychologist, of course, told me that everything we thought that we knew about this child was wrong. And she had data with which to back it up. Can we really make this better? Others are calling, being but on waiting lists that subsequently are lost. One lad really does like his counsellor; he's making progress. And FST called me about a patient as well; they are (apporpriately concerned). All of them see the system as broken and are looking forward to the reforms promised under Rosie D and the Children's Mental Health Initiative.
More to follow.

Tuesday, April 8, 2008

Lots of meetings this spring

Turns out that Common Pathways in Worcester is interested in hearing about your vision for better mental health services (among other things)  in Central Massachusetts.  Be good if people could be there.  RSVP to Common Pathways.

A Field Trip: Resident's Day at the State House.

Wow.  The Residents of the Massachusetts AAP organized a fantastic program for Residents Day at the State House, and I got to go.  We got to hear Jack Shonkoff talk to us about how science and policy interact;  John McDonaugh talk about politics; and watch a group of really energized residents go out and talk to their legislators.  Let me try to capture some of what they had to say:
Jack  was superb, talking about his transition from scientist to policy maker, describing his journey with his usual brilliance.  I took lots of notes, but his advice essentially could be summed up in three points;
  • TEACH DON”T PREACH:  We have to close the gap between what we know and what we do, by being smarter about how we bring the science to the table.  Teachers know that they have to meet their students "inside their own heads"- that is the basis of adult learning theory.  He is working with a group called  The Frameworks Institute, which has developed a wonderful rubric for learning about the Frames that guide our thinking and finding language that communicates what we are trying to say.
  • EXPLAIN DON”T COMPLAIN.  It is easy to complain-  by working on policy, we acknowledge that the boundaries of pediatrics need to extend beyond the audience, if we are going to make a difference for children.  He made a point that others made throughout the day;  we are at our most effective when we are knowledge brokers, working with advocates for the benefit of children.
  • RELATE DON”T BERATE.  Politics is all about building relationships.  In particular, with folks that we sometimes think of as "not like us".  Almost everyone cares about children, but there are a wide range of beliefs around how that is best done.  (As most of us docs know from the practice of medicine)  We as pediatricians need new partners:  Change happens when we make the relationships happen.

There's more-  I will try to work it into the blog later.  Check out his stuff at Harvard: The Developing Child,  Jack is where we all need to be.

Monday, April 7, 2008

Taking the Long View: What is going on around the country?

My Academy has a couple of interesting things in it websites for those of us embroiled in mental health reform;  please keep in mind that we are actually doing pretty well.  The AAP has given awards to 10 Chapters for their efforts in changing the paradigm for children's mental health care in their states.  Check it out here!  Chapter efforts include building local networks of pediatricians and mental health providers, improving communication and coordination between statewide profession organizations, needs assessments in major urban centers, creating resource directories and promoting  “dialogues in mental health in primary care” meetings between pediatricians, family practitioners, child psychiatrists, and community mental health providers.  As I read through the list, I was impressed by the commitment of pediatricians to address this problem, and how the rest of the country is adopting many of the same techniques that we have used in Massachusetts to get us to the cusp of major system change.  Whenever I get frustrated at the pace of change in Massachusetts, I need to take a look around and realize how long it has take to get us to here.
Second, is a really interesting article from about 4 years ago that looked as mental health service utilization and mental health needs in 13 states from a parental perspective.  They showed that service utilization is not simply predication by need or demographics.  In California, the rich folks get more services than do the poor folks.  In Massachusetts, the opposite is true.  " In Alabama and Mississippi, as well as in the states with the lowest rates of unmet need (Colorado, Massachusetts, and Minnesota), the opposite is true: children from low-income families are much more likely to receive any mental health service than children from high-income families."  Despite Rosie D., Massachusetts frequently does mental health services better than the rest of the country.
Doesn't get us off of the hook.  But somehow, I find it comforting.

Save the Date and Watch PBS

Please come to the Worcester Mental Health Forum on May 2, 2008.   Also, note that on April 8, 2008, PBS will air another special: The Medicated Child.   I just read the transcript, and it looks worthwhile;  pointing out how little we know about how mental illness works in children.  Food was thought as we build the new system.

From the MCH Listserve


The Mental Health of Adolescents: A National Profile, 2008 highlights existing national data about adolescent mental health status, assesses shortcomings of current data, and offers recommendations to address these shortcomings. The brief, produced by the National Adolescent Health Information Center at the University of California, San Francisco, with support from the Maternal and Child Health Bureau, reviews definitions of mental health and describes methods for assessing mental health status. To describe the prevalence of mental health problems, the authors organize the findings as follows: global estimates of behavioral and emotional problems, estimates of specific disorders, suicide, and utilization of mental health services. A conclusion, national data sources cited in the brief, and references are provided.
The brief is intended for use by health professionals, policymakers, educators, and others in strengthening systems that monitor the mental and emotional health of young people at national, state, and local levels. The brief is available at Brief.
Couple that with this, from the Journal of Adolescent Health:
Trends in the six objectives in this area mostly show modest or no improvement. The suicide rate for younger and older adolescents remains essentially unchanged, as does the percentage of adolescents who report suicide attempts that require medical attention. Trends in the two substance use objectives—binge drinking and marijuana use—show fairly small decreases. The midcourse review shows modest improvement in the two remaining objectives: the proportion of children and adolescents with disabilities who are reported to be sad, unhappy, or depressed, and the proportion of children with mental health problems who receive treatment. If these trends continue, only the last objective will meet its 2010 target.
Must be Monday;  lots of work to do.

Friday, April 4, 2008

The view from SAMSHA: What do Children (and Adolescents) Need

This week, I was fortunate to have the opportunity to hear Terry Cline PhD talk at Judge Baker Children's Center, as the penultimate speaker in a series that I discovered much too late in the year.  The room was packed to hear this Judge Baker alumnus speak of the role of the Federal government in facilitating the care of children with mental health problems in America.
He has been at SAMHSA for 14 months, after several years as Commissioner of Health or Mental Health (or both) in Oklahoma. His roots, however, were in home based mental health services; he used to be at Cambridge Youth Guidance Center and his first job was providing home based therapy in Cambridge and Somerville. He remembered that his training didn’t prepare him for the level of violence that his clients would live with on a day to day basis and the impact of poverty on the lives of families. Every day, he would walk by 15  families who would have benefited from his service on the way to the home of one family that he was able to serve.  This experience has informed his career as he has risen through the ranks.

He feels that the health care system that we have now is unsustainable, and that the new system will be different. The opportunity now is to shape the health care system to include behavioral health as a key component.  He pointed out that the challenges are not new: most are familiar to folks in the system for 30 years.  Therein lies the challenge.  To quote 
David Satcher, "The gap between what we know and what we do in public health is lethal to Americans, if not the world”  

He made a view points about SAMHSA:
  • Vision: A life in the community for everyone.
  • Mission: Building resilience and promoting recovery using a public health approach.
He used the old story of the townspeople who exhausted themselves rescuing drowning people from  the stream, before that someone had the idea of going upstream and checking out what was going on.  He sees the problem as systemic: The health care system provides incentives and rewards for treating acute illness, and has led us to a crisis management system, especially in mental health and substance abuse.  He thinks that we need to focus on  Prevention as much as Treament, and to reemphasize Recovery (much along the lines of the Chronic Disease model)

He then sounded themes that we have heard in the context of Rosie D:
  • Need to emphasize the connection between primary care and behavioral health providers to maximize the effectiveness of our workforce, and to focus our interventions "upstream".
  • Neeed to bridge the scientific community and the "community care community" to bolster the evidence base, which is often lacking.
  • We need to integrate mental health services with the rest of the community that is caring for the child.
If we can integrate these services, we will succeed, by developing a public health approach that drives us toward the children. If we don’t do this, the system will fail.

He cited the data that is driving this push:
  • ACE study: Early trauma adversely impacts lots of adult outcomes.  Big time.
  • NASMHPD Study: Serious mental illness takes 25 years off your life.  Really.
  • ½ of mental illness starts by age 14.
  • ¾ of mental illness start by age 21
  • 1/10 of  American youth will have major depressive episodes.
  • In the US.  23 million people are in need of services and 2.5 million receive services.

What works:

System of care make a difference:  At the Federal level, the Children’s Mental Health Initiative has tripled expenditures, but it is still only a drop in most State budgets.  Kids involved in these demonstration initiative are referred in through schools and agencies throughout the country and show better behavior and fewer juvenile justice problem.  The Administration has asked for an increase of $12 million for next year.

There is an ambivalence about substance abuse: We value medications and at some level, attach social value to drug use.   Still, our current initiatives have led to a 24% decrease in use of illicit drugs over the past 5 years. (  MJ, methamphetamine, cigarettes, alcohol )

We are starting the conversation to change the norm:  “A Day in the Life of an Adolescent” is a report that apparently translates the rates into reality. On any given day,  8000 teens take their first drink, and 4300 using their first drug. Also, he pointed out that prescription drug abuse is growing. We still have work to do.

He is very excited by the publication of new report,
PROMOTION AND PREVENTION IN MENTAL HEALTH: Strengthening Parenting and promoting resiliency that he thinks will be very helpful in moving the discussion forward.
So, how do we engage in prevention, or "move upstream"?
1) We need to going out to the schools: Headstart,  Child welfare, schools-  all must be engaged in the discussion.
2) W need ncouraging screening within the system.  (As we are doing as part of the Rosie D remedy).  Now that the Federal government has approved codes for SBIRT, we need to encourage its use.  
3) We need to improve access to services through primary care.
4) We need to recognize our allies and work with HRSA and other parts of the Federal System.
5) Sees SBIRT screening as a good thing. Should be done in Emergency Room.
So, how do we encourage recovery?.  Some of that is mantaining the relationships that make this all possible.  SAMHSA has been advocating for the involvement of families and youth in the design and delivery of systems. 

He also sees many challenges before us:  
  • We need a national initiative to address ethnic disparities in mental health care. There is lots of great work out there, but it needs to be pulled together
  • 32,000 people across the country commit suicide each day.   This must change.
  • At least 1/3 of incarcerated people have mental illness.   How do we deal with this?
  • Many feel that it costs too much to treat mental illness. Untreated mental health conditions costs all of us.
Overall, he was upbeat, optimistic and sees the Federal government as a spark for change at the state and local level.  I did not hear much in the way of specifics that will break down the system-  he doesn't see the Federal government's role as telling those of us in the field what to do.  He did, however, send a clear message that, whichever administration is in power, mental health and substance abuse treatment will be seen as important issues that need local solutions.  Rosie D may give Massachusetts the opportunity to lead the way.

I've been a little tired...: Thoughts after responding to an RFI

So, as it used to say on the top of the blog, the Worcester Mental Health Network's Response to the the EOHHS Request for Information went in at 1:30 PM EDT on April 1, 2008. 68 questions, many of which I couldn't answer, we considered, and discussed by our group, and I think that it is fair to say that the Central Massachusetts voice was heard. Also, I sang four concerts over the weekend, and by Tuesday night was pretty tired. I guess I took a breather on the blog after that. I was a little tired.

So what now?

I have a few things I want to post. I had the opportunity to heard the Administrator of SAMSHA talk on Wednesday, and I took copious noted that I should be posting later today. The Worcester Mental Health Network Steering Committee met on Wednesday, and formulated our action plan for the spring. I'll write some about that. And, I have some more patient stories that I hope can inform our efforts that I need to pull together. So, stay tuned.

Wednesday, April 2, 2008

Side comment: Gershwin is fun!

When not doctoring, I actually sing in the Providence Singers.  Take a look at this cool slideshow from our recent Concert.  One more chance to see us do Gershwin this week. 

The Providence Singers Take Gershwin on the Road

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