Mental Health Administration

Critical Issues in Mental Health Administration and Leadership

Dr. Martin Wesley

Critical Issues in Mental Health Admin

• Research and Practice– Evidence-Based Treatment

– Policy’s Impact on Treatment

• Finance

• Technology

Evidence-Based Treatment

1. The clinician constructs a specific clinical question concerning the care of a patient or group of patients

2. The clinician finds the best evidence to answer the question

3. The clinician evaluates the evidence for validity and usefulness

4. The results are applied to the specific patient or group of patients

5. The outcome of the intervention is evaluated

Sounds Good but…

• Quantitative research only?

• What about qualitative? - Practice-based evidence?

• What is measurably effective? – 10%, 50%, 95%?

• Is experimental data better than observational data?

• What about risks – Effectiveness vs. side effects? Side effects or risks to others, society, families and others

• What about Cost-Effectiveness?

• Are we making the problem worse? examples

Example – Addiction Treatment

• What works…

• Brainstorm - come up with evidence-based practices for addiction treatment, then

• Effectiveness?

What about…

• Length of treatment

• Level of treatment

• Type of treatment

• Definition of success

• What constitutes failure

• Treatment follow-up

Political Correctness

• Political Correctness often plays a part in mental health treatment

• Product marketing – especially in drugs

• www.havidol.com

• Monopoly in treatment

• Push toward victimization, maintenance and long-term recovery instead of defeating and curing, even for conditions that are not SMI

Mental Health Text pg5

• “Because the goal of evidence based medicine is to improve the quality of clinical judgments, it encourages decisions based on clinically relevant research and minimizes decisions based on outdated information, local practice patterns, product marketing literature, or subjective and conflicting opinions of medical experts.”

3 basic directions that administrators will follow to move toward EBP• They will increasingly rely on external expert

intervention design, based on previously tested strategies and premarket assessment of potential service delivery organizations.

• These interventions will be disseminated to managed care organizations, through marketing, negotiation, and training

• Continuing education for all clinical staff to practice correctly and to administrators to determine outcomes and impacts

Policy’s impact on Treatment

• Focus on Prevention?

• Marketing of services?– Do you feel…?

• Priority Populations – (usually financially motivated)– SMI

– Children

– Crisis

– How would you prioritize?

Stigma

• Would most people rather live or work by an ex-convict or ex-mental patient?

• According to the text and popular opinion, education is needed to reduce stigma and ignorance about treatment.– What about Drug abuse, pedophilia, child abusers, and

other “deviant” behavior? Disease or Choice?

• Will we ever reduce the stigma when there are so many abuses of the system? Ineffective treatments?

Parity

• Mental Health care attempts to overcome discrimination and reduce stigma but policies are often difficult to implement to provide this uniformity for all.

• Some states provide services for all DSM-IV DX while others only provide for “biologically based” severe mental disorders

• Exemptions – such as small employers

• Who is going to assume the risk and pay for it.

Current News• Mental illness leads to earlier deaths• United Press International - May 04, 2007 WASHINGTON, May 3, 2007

(UPI via COMTEX) -- U.S. public hospital directors say people with serious mental illness die 25 years earlier than the average person in the United States.

• The report, which looks at patients with mental illness in public health systems, said people with serious mental illness die at an average age of 51, compared with an average age of 76 for most U.S. adults, USA Today said Thursday.

• Lead author Joseph Parks, director of psychiatric services for the Missouri Department of Mental Health, said the gap has widened since the early 1990s.

• The report, which looks at Maine, Massachusetts, Rhode Island, Oklahoma, Missouri, Texas, Utah and Arizona, will be released Monday at a meeting of state hospital directors, the newspaper said.

• Parks said certain anti-psychotic medications can cause drastic weight gains, promoting diabetes and heart disease. He said the patients are also more likely than others to smoke and have alcohol and drug-abuse problems.

Finance

• Managed Care– Mental health is usually separated from general health

care benefits through contractual agreements with specialized vendors such as Magellan also know as Managed behavioral health care organizations

– Goal to decrease hospitalization and other expensive services

– Significant declines in costs and services

Payment

• Capitated fee payments (block purchase of services) vs. Fee per service

• Who assumes the risk?

• The more services one provides the less money is made

• The state has not increased state funding in 15+ years for mental health.

• Only novelty programs get funded - politics

Entitlement Programs

• Entitlement programs has been the primary source of income for Mental Health Services

• Most money goes for treating acute needs, SMI, Children while having only limited mental health care for others and no substance abuse benefits

Technology

• Mental Health is going High Tech

• Computerized session notes, TX plans, and more.

• Session notes are monitored for effectiveness and tied to goals

• Orientation and Continuing Education is now being done online to reduce costs to employers

• Confidentiality and Security, storage and retrieval