1) Canada is having a mental health crisis as well. We heard from our Canadian brethren that, despite the many advantages of Universal Health Care, they had poor access to mental health workers and child psychiatrists, similar to many of the issue we are trying to address in the United States.
2) Other states are working on mental health system issues, and they are all fascinated by MCPAP. Connecticut has not yet been able to put our model in place, Virginia is planning to do so and Tennessee is doing similar sorts of things.
3) States have differing degrees of public-private collaboration. The Vermont Departments of Health and Mental Health are developing statewide protocols for management of common behavioral health problems of children by primary care providers through a series of learning collaboratives.
4) Carve outs can be more collaborative: In North Carolina, the primary care provider can authorize the first 26 visits to a mental health worker without oversight, and the mental health worker can see them for 6 visits without a diagnosis. They've also established laws to allow LCSWs (not independent) to work under the supervision of a pediatrician, and allow mental health providers who don't work for community mental health agencies to see Medicaid patients, two major barriers to care in Massachusetts.
North Carolina has also taken pro-active action to encourage co-location of mental health workers and physicians working with children. They are giving out small grants to encourage the start up, and I believe are also reimbursing at a preferential rate.
We are doing OK, as I said below, but we can learn things from our colleagues throughout the US. And Canada.
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