Health Equity Can’t Wait: Embracing the Imperative

Mirtha R. BeadleDeputy Administrator for Operations

SAMHSA April 18, 2012

Why Now?

• The stage has been set• Affordable Care Act of 2010• HHS Action Plan to Reduce Racial and Ethnic

Health Disparities• National Stakeholder Strategy for Achieving

Health Equity• We are on the right path!

Mary’s Story

Mary, a 30 year old African American female:• complained of recurring infections• sought care but was turned down because of

her Medicaid status• had polycystic ovarian disease, endometriosis,

and possibly cancer of the cervix or uterus

Without integrated behavioral health and primary care her problem would have remained undiagnosed

Change does not roll in on the wheels of inevitability, but comes through

continuous struggle.

─Martin Luther King, Jr.

Snapshot

• Half of Americans will meet criteria for mental illness at some point in their lives (Kessler 2005)

• 7% of the adult population (34 million people), has co-morbid mental and physical conditions within a given year (Alegria 2003)

• 24% of pediatric primary care office visits and ¼ of all adult stays in community hospitals involve mental and substance use disorders (Cooper 2007)

• People with cardiovascular disease are 43% more likely to have anxiety disorder at some point in their lives (Goodwin 2008)

Expenditures

$- $1,000 $2,000 $3,000 $4,000 $5,000

$751

$1,999 $2,739

$4,032

$680 $1,601

$2,627

$4,717

$212

$1,382 $2,052

$3,233

Mental Health Service Users Substance Abuse Service UsersAll Other Medicaid Beneficiaries

SAMHSA. (2010). Mental health and substance abuse services in Medicaid, 2003: Charts and state tables. HHS Publication No. (SMA) 10-4608.

Framing the Imperative:Primary and Behavioral Health Care

Equity• Facilitating partnerships between primary care

and behavioral health providers to improve patient outcomes

• Developing health professionals with competencies in primary behavioral health care integration is a key component of sustaining integrated service delivery

• Ensuring equitable access to integrated primary and behavioral health care services

The Current Context1

• Integrated FQHCs operate in at least 35 states• Proportion of patients with mental illness treated

at FQHCs is small (miniscule for substance use)• Recruiting and retaining behavioral health

specialists represent a significant challenge• Less than half of integrated FQHCs receive

outside assistance• Access to community mental health agency

services are serious problems for health centers1NACHC 2010 Assessment of Behavioral Health Services In Federally Qualified Health Centers

The PBHCI Example

The Primary and Behavioral Health Care Integration (PBHCI) program focuses on individuals with severe mental illness (SMI) and co-occurring substance use disorders served in the public behavioral health system to:• improve physical health status of people with SMI and

co-occurring substance use disorders• support communities to coordinate and integrate primary

care services into publicly funded community-based behavioral health settings

• establish partnerships to develop or expand primary healthcare services

PBHCI Clients1

• 13% of consumers have been Hispanic• 22% of consumers have been African American• 58% (n=3,816) of consumers reported that their health

was fair or poor • 61% (n=3,787) of consumers reported using tobacco in

the past 30 days• 27% (n=1,678) of consumers reported alcohol use in the

past 30 days • 37% (n=590) of drinkers reported binge drinking

1Cumulative TRAC data through 10/19/11

PBHCI Treatment Outcomes1

(% of Consumers)

• Positive functioning in everyday life (dealing effectively with daily problems, crises, social situations, school/ work) increased by 26% from baseline to most recent reassessment (N=3,448)

• Overall health positively increased by 13% from baseline to most recent reassessment (N=2,573)

• Not using tobacco substances increased by 5% (N=2,601)

1Cumulative TRAC data through 10/19/11

When one door closes, another opens. But we often look so long and so regretfully at the closed door that we do not notice the

one which has opened for us.

―Helen Keller

Lightning in a Bottle, D. Baum

Taking Action:Embracing the Imperative

• Understand the impact of service integration on racial, ethnic, and other populations

• Harness existing resources to enhance services• Align and partner with like-minded organizations

to support policies, programs, and activities for health achieving equity

• Create, support, and sustain community capacity and innovation

• Make critical decisions that allow adoption or adaption of proven models

We Can’t Wait

Health inequity really is a matter of life and death.

─Margaret Chan, MD, MPH