Value-Based Financially Sustainable Behavioral Health Components in Patient-Centered Medical Homes

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Because a high percentage of primary care patients have behavioral problems, patient-centered medical homes (PCMHs) that wish to attain true comprehensive whole-person care will find ways to integrate behavioral health services into their structure. Yet in today’s health care environment, the incorporation of behavioral services into primary care is exceptional rather than usual practice. In this article, we discuss the components considered necessary to provide sustainable, value added integrated behavioral health care in the PCMH. These components are to:(1) combine medical and behavioral benefits into one payment pool; (2) target complex patients for priority behavioral health care; (3) use proactive onsite behavioral “teams;” (4) match behavioral professional expertise to the need for treatment escalation inherent in stepped care; (5) define, measure, and systematically pursue desired outcomes; (6) apply evidence-based behavioral treatments; and (7) use cross-disciplinary care managers in assisting the most complicated and vulnerable. By adopting these 7 components, PCHMs will augment their ability to achieve improved health in their patients at lower cost in a setting that enhances ease of access to commonly needed services.

Roger G. Kathol, MD1,2

Frank deGruy, MD3

Bruce L. Rollman, MD, MPH4

Published in the Annals of Family Medicine

Full Article (PDF)

Video — Integrating Mental and Physical Healthcare: Roger Kathol

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How would your healthcare experience be different if you could obtain best-practices mental healthcare and physical healthcare in one place? This topic has been pretty buzzworthy in recent mental health advocacy. For example, Mary Palafox’s essay from IMHRO’s 2013 Brainstorm Essay Contest, Reclassify All Organic Brain Diseases Under Medicine, explores some of the reasons why integrating healthcare might benefit people with severe mental illness. Now, with the provisions of the Affordable Care Act, this integration is gaining steam. One doctor who has dedicated much of his career to this integration process is Roger Kathol, M.D., C.P.E. He joins us on this month’s Brain Waves segment to discuss the whys and hows of healthcare integration, as well as why some stakeholders oppose it.

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–International Mental Health Research Organization

Inclusion of Excellence Act in Medicare “Doc Fix” — $900 Million Dedicated to Mental Health Services

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Washington, DC (March 26, 2014) — Congressional negotiators released a final Medicare SGR Repeal bill today that includes $900 million to fund the bipartisan Excellence in Mental Health Act. The Excellence Act, sponsored by Senators Stabenow (D-MI) and Blunt (R-MO) along with Representatives Matsui (D-CA) and Lance (R-NJ), would improve quality and expand access to mental health care and substance use treatment through community behavioral health clinics. The legislation would establish a two year demonstration program in eight states to offer a broad range of mental health and substance abuse services like 24-hour crisis psychiatric services while setting new high standards for providers. The legislation now moves to both chambers for consideration.

“After decades of devastating state and federal budget cuts, the time has come to reinvest in mental health and substance abuse services. The Excellence Act does just that.” said Linda Rosenberg, President and CEO of the National Council for Behavioral Health.  “As many as 240,000 people will be able to receive critical mental and behavioral health services as a result of Excellence Act funding.  When people receive the quality mental health and substance abuse services they need, the benefits of treatment extend far beyond the individual – to their families, their professional colleagues and their community at large. We are all better off when quality mental health and substance abuse services are available.  This is an historic day and it would not have been possible without the tireless work of Senator Debbie Stabenow and the bill’s bipartisan sponsors.”

The National Council for Behavioral Health has long been a champion of the Excellence Act, which expands access to evidenced-based community health care for children and adults with serious and persistent mental illnesses. If enacted, the legislation will reduce high hospital emergency room utilization among persons living with behavioral health conditions while easing the burden on hard-pressed law enforcement agencies in urban and rural areas.  Additionally, the Excellence Act demonstration will assist the Veterans Administration (VA) with serving the young men and women returning from Iraq and Afghanistan with service connected mental disorders including clinical depression and PTSD.

The National Council for Behavioral Health is the unifying voice of America’s community mental health and addictions treatment organizations. Together with our 2,000 member organizations, we serve our nation’s most vulnerable citizens — the more than 8 million adults and children living with mental illnesses and addiction disorders. We are committed to ensuring all Americans have access to comprehensive, high-quality care that affords every opportunity for recovery and full participation in community life. The National Council pioneered Mental Health First Aid in the U.S. and has trained nearly 150,000 individuals to connect youth and adults in need to mental health and addictions care in their communities. Learn more at

May 4th Mental Health and Dignity Day: Organizing Events in Communities Near You

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Mental Health and Dignity DayEvery year communities across the country recognize mental health awareness in the month of May. This year a group of advocates are organizing to proclaim May 4th as Mental Health and Dignity Day. They are using the power of social media and grass roots organizing as a way of encouraging others to organize events in their local community on this day. The idea started with one person, which lead to a logo design and now a group on facebook that is quickly growing by the 100′s. The purpose is as follows: This group was started to organize local events where we honor all members of our community, recognize that mental health is something that deserves positive support and continue the fight against stigma towards mental illness.

As many as 60 million Americans struggle with mental health concerns and this is a public health issue that has come to the forefront through numerous events that have made international headlines. From gun control to healthcare, mental health is on the minds of many citizens and part of wide spread debate. What matters most is that mental health is a part of whole health. Every person struggles with their mental health at some point in life and many may experience significant life interruptions as a result of it. What research and practice has taught us in recent years is that people can and do recover. This day is meant to promote the dignity of every person and recognize that mental health is something we all have in common and can celebrate the positives that come from experiencing wellness. We also must recognize that many who suffer from life circumstances that have a negative impact on mental health such as poverty, trauma and abuse, stigma and lack of access to adequate care, do not have a voice and need to be supported as equal members of society.

As the movement continues to grow, this group intends to support communities in organizing events, raising funds to produce t-shirts, gain support from national organizations, media and key leaders in the community. To find out more about how to get involved, visit their group on facebook: and their fundraising campaign for the purchase of t-shirts with logo below and support for local events:

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April 8th Webinar: “Brain Plasticity: What Is It and Why Is It Important?”

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Meet the Scientist logo

Tuesday, April 8, 2:00 p.m.–3:00 p.m. Eastern Time

Speaker: Bruce S. McEwen, Ph.D.

Alfred E. Mirsky Professor

Head, Harold and Margaret Milliken Hatch Laboratory of Neuroendocrinology
The Rockefeller University
Dr. McEwen’s research has contributed significantly to elucidating the impact of stress and sex hormones on the brain’s chemistry and structure. Dr. McEwen’s emphasis is on the mechanisms underlying adaptive structural plasticity. Estrogens and androgens induce new synaptic connections in the brain. They also modulate, for better or worse, damage from stroke, head trauma and seizure, as well as age-related changes in brain function. In studying both stress and sex hormones as regulators of structural plasticity in the adult brain, Dr. McEwen and his team examine sex differences and how they develop, along with the influence of early life experiences, in affecting learning, memory and predisposition towards disease.

Dr. McEwen was an assistant professor at Rockefeller in 1966 and was named Alfred E. Mirsky Professor in 1999.

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Video of the AEI Event, “Fixing the mental health care system: What Congress can do”

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More than 9 million Americans have a serious mental illness, more than 3 million do not have treatment, and between 20 and 50 percent of all US inmates have a mental illness. How can we attempt to combat these challenges? On Friday, AEI’s Sally Satel hosted Representative Tim Murphy (R-PA) to discuss flaws in current mental health policy and the changes he hopes to enact via his Helping Families in Mental Health Crisis Act. Rep. Murphy identified key areas that require significant change, such as addressing shortage in inpatient treatment, looking to alternatives to institutionalization, and proactively providing quick and fair treatment to all mental health patients.

See video and more information

Effexor XR Recall (3 lots)

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A voluntary nationwide recall of 3 different lots of the antidepressant venlafaxine (Effexor, Pfizer Inc) has been issued by the drug’s manufacturer owing to possible contamination with a heart drug and subsequent potentially fatal consequences.

As a precaution, Pfizer Inc is recalling 1 lot of 30-count Effexor XR (venlafaxine HCI) 150 mg extended-release capsules, 1 lot of 90-count Effexor XR (venlafaxine HCl) 150 mg extended-release capsules, and 1 lot of 90-count Greenstone LLC-branded venlafaxine HCl 150 mg extended-release capsules.

According to Pfizer, the action is being taken because 1 bottle of Effexor XR contained a single capsule of dofetilide (Tikosyn, Pfizer Inc) 0.25 mg, an antiarrhythimic medication used to treat atrial fibrillation/atrial flutter and maintain normal sinus rhythm.

Pfizer says the probability that other bottles of Effexor XR have been similarly contaminated is low but that it has issued the recall as a precaution.

This recall involves Pfizer lot numbers V130142 and V130140, which both expire in October 2015, and Greenstone lot number V130014, which expires in August 2015.

Police Confront Rising Number of Mentally Ill Suspects

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James Boyd, a homeless man camping in the Sandia Foothills here, could hear the commands of the police officers who were trying to move him out.

The problem was that Mr. Boyd, 38, had a history of mental illness, and so was living in a different reality, one in which he was a federal agent and not someone to be bossed around.

“Don’t attempt to give me, the Department of Defense, another directive,” he told the officers. A short while later, the police shot and killed him, saying he had pulled out two knives and threatened their lives.

The March 16 shooting, captured in a video taken with an officer’s helmet camera and released by the Albuquerque Police Department, has stirred protests and some violence in Albuquerque and prompted the Federal Bureau of Investigation to begin an inquiry into the death. But it has also focused attention on the growing number of people with severe mental disorders who, in the absence of adequate mental health services, are coming in contact with the criminal justice system, sometimes with deadly consequences.

by Fernanda Santos and Erica Goode, The New York Times

Full Article

Preparing for the Knock on the Door

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The knock on the door I knew would someday come was here. It was a bitter cold January night, about 11:15 pm. Two very kind but somber police officers brought news I already had felt in my heart—that my son was never coming home again. My son Joey had been killed earlier that evening. He was the victim I saw wrapped in a white sheet, laying on the pavement on the evening news.

I tried to prepare for this day, for most of my life. Now that it was here I wanted to scream, “No! Not yet! Not now! I’m not ready. It’s too soon. I just talked with him this afternoon and he seemed fine.” But the truth was, he was a little manic; writing a new essay on his computer, making lists for items he would need to begin a new career path—refurbishing properties—preparing to paint his room, and going out to buy a new wristband for his watch.

Since the mental health professionals wanted him to be emancipated from his family I had looked at a property that a friend had that was for sale, that needed to be refurbished, and one in which Joey might live. Although Joey had some experience refurbishing properties, I honestly didn’t understand how the “professionals” thought this plan was supposed to work. He was 45 years old and had never lived on his own. Nevertheless, Joey said, “Yes,” he would be home when I got there around dinnertime. “Yes,” he said, we would then go look at the property.

This would have been the first property that he could live in while he worked on renovating it. He could become independent, which is what his mental health providers had been pushing him to do.

The only other thing I can remember him saying, that last day of his life, was: “Mom, I am so sorry for all the worry I have given you. It will get better soon. I love you.” I have searched my memory many times trying to remember anything else we might have said to each other during that last exchange. But I always came back to those last words: “I love you” because ultimately, what else matters?

What happened between the time I received his telephone call that afternoon and 6:23 pm. that evening, when he ran into interstate traffic is open to speculation. It is my opinion that he just gave up the fight. Do I believe he committed suicide? No, not consciously. Whatever went on in Joey’s mind was not preplanned. It just happened, on the spur of the moment, like so many other things that had happened in his life. It happened without reasoning of the consequences. You see my son was mentally ill.

I can say that now as casually and as a matter of fact as a parent might say, “My child is diabetic,” or “My child has asthma,” or “My child is class president.” Saying someone is mentally ill is usually said—in jest—when your child, or someone does something incredibly stupid. However, I can tell you there is nothing funny about mental illness. When did I stop thinking that discussing the fact that you have a child with mental illness was not something you talked about in polite conversation? Sadly, not until the day he died.

The reasons most people don’t talk about mental illness are varied and multiple. With me it was because of how my son dealt with his illness. It seemed he often felt ashamed and ostracized, as if no one would accept him as a person worthy of love.

Surely we can do better.

I hope my story will help remove the stigma from those with mental illness, and bring those who suffer from this condition an opportunity to come forward and be allowed the dignity to live a productive life; one that does not include jail or prison, as that is how society seems to control a large percentage of our mentally ill population.

To effect changes to the system that is currently in place, we must start by talking to our loved ones. We must be unafraid to share with the world what it’s like to live with those afflicted with mental illness. Mental illness is not the fault of the person. Mental illness is a biological fault sometimes made worse by environment.

We seem to have a need to blame someone for the condition; especially the afflicted one. Hopefully my story will put the “blame” where it belongs; with man’s inhumanity to mankind. When the answers and solutions are not at our fingertips, experts shrug their shoulders and walk away.

Excuses should no longer be tolerated. I believe this is one of the last “closet doors” we need to open. Mental illness affects almost everyone; most simply do not even realize.


Published by The Treatment Advocacy Center

Full Article