Fixing Behavioral Health Care in America
COMPASS is featured as a real world case example this Kennedy Forum issue brief entitled Fixing Behavioral Health Care in America, co-authored by Jürgen Unützer MD. You’ll also learn about other promising approaches emerging from University of Washington’s Advancing Integrated Mental Health Solutions (AIMS) Center, in conjunction with The Kennedy Center for Mental Health Policy and Research. Read the issue brief.
COMPASS Shared Learnings
Partners were asked to share lessons learned around sustainability or additional evaluation of their COMPASS work.
Community Health Plan of Washington Toolkit (Neighborcare Health)
Community Health Plan of Washington (CHPW) and Neighborcare Health, a Federally Qualified Health Center (FQHC) and one of the community health centers in the CHPW network, together created this toolkit to share lessons learned. It includes background information about collaborative care and a robust description of how this FQHC implemented the COMPASS model for others interested in initiating a similar program. View the Toolkit (PDF).
Expanding the Scope of the COMPASS Program (MiCCSI)
Health care leaders and institutions throughout the country recognize that the care of patients with multiple chronic conditions (MCC) is inadequate and enormously costly. While the COMPASS program shows great promise in improving care and reducing costs, it cannot be sustained with its current clinical focus. This report from the Michigan Center for Clinical Systems Improvement (MiCCSI) aims to address a primary question that COMPASS consortium partners are asking: Can COMPASS scale to become an established part of patient care for an operationally meaningful proportion of health care populations with MCC? View the paper (PDF).
Exploration of Potential Actions to Improve Follow-up Contact Rates for “Hard to Reach” Patients (PRHI)
The goal of this project was to identify and disseminate best practices for improving rates of follow-up contacts between care managers and patients. Previously, the Institute for Clinical Systems Improvement (ICSI) created a guide to best practices for the content and quality of follow-up contacts, and the Pittsburgh Regional Health Initiative (PRHI) developed a list of best practices for the systematic case review process by learning from the medical groups with the highest percentages of systematic case reviews among patients with at least one missing value or one value above goal. Download the paper (PDF)
Complexity Tools: Sorting out Patient Needs
Sometimes life gets in the way. For COMPASS patients, it can be hard to navigate the complexity of their medical conditions as well as their social complexities. C.J. Peek shares examples of tools to assess a patient’s complexity, and how these tools can be beneficial in caring for our COMPASS patients. View the Presentation (PDF).
Presenter: C.J. Peek, PhD; Professor, Depart of Family Medicine and Community Health; University of Minnesota Medical School
Stigma Tool Kit
Thank you to the following COMPASS partners for contributing ideas and resources:
Marc Avery, University of Washington; Karen Coleman, Southern California Permanente Medical Group; David Price, Kaiser Permanente Colorado; Mark Valenti, Pittsburgh Regional Health Initiative.
Books
- Patients and Healers in the Context of Culture by Arthur Kleinman
- The Spirit Catches You and You Fall Down by Anne Fadiman
Research Highlights 2005-2014
Bell, R. Suffering in Silence: Reasons for Not Disclosing Depression in Primary Care. Ann Fam Med 2011;9439-446.
Telephone survey of adults asked about reasons for nondisclosure of depressive symptoms to their primary care physician. The most frequent reason was the concern that the physician would recommend antidepressants. Respondents with no depression history were more likely to believe that depression falls outside the purview of primary care and more likely to fret about being referred to a psychiatrist.
Blaire, E. Unconscious (Implicit) Bias and Health Disparities: Where Do We Go from Here? Perm J. 2011 Spring; 15(2): 71–78.
Demands of a busy medical practice leave little time for reflection and the fulfillment of even the best intentions. Biases must be rendered less implicit and unconscious to foster real reflection, analysis and change. Gut reactions to specific individuals or groups may be potential indicators of implicit bias. Identify biases that may be active in the community. Affirm equity of care and diversity as core organizational and institutional values.
Givens, J. Ethnicity and Preferences for Depression Treatment. Gen Hosp Psych 29 (2007) 182–191
Survey of people with significant depressive symptoms. Compared to whites, African Americans, Asians/Pacific Islanders and Hispanics were more likely to prefer counseling to medications. Ethnic minorities were less likely to believe that medications were effective and that depression was biologically based, but were more likely to believe that antidepressants were addictive and that counseling and prayer were effective in treating depression.
Griffiths, K. Does Stigma Predict a Belief in Dealing with Depression Alone? J Aff Disorders, 2011.
Personal stigma predicted a belief in the helpfulness of dealing with depression alone. Men and older people were more likely to believe in coping alone with depression accompanied by suicidal ideation. Personal stigma might be one element that could be targeted in an intervention designed to encourage help seeking by those who prefer to deal with their depression alone or who believe that others should do so.
Kaner, E. Seeing Through the Glass Darkly? A Qualitative Exploration of GP’s Drinking and Their Alcohol Intervention Practices. Fam Pract Adv Access, 2006.
Alcohol is clearly a complex and emotive health and social issue and GPs are not immune to its effects. For some GPs’ shared drinking behavior can act as a window of opportunity enabling insight on alcohol issues and facilitating discussion. However, other GPs may see through the glass more darkly and selectively recognize risk only in those patients who are least like them.
Kuehn, B. Men Face Barriers to Mental Health Care. JAMA, Nov 15, 20006-Vol 296, No.19
Rather than presenting with depressed mood or sadness, men may report irritability, stress, somatic complaints, or cognitive dysfunction. Suggests physicians probe further and look for other signs such as weight loss, sleep problems, or individuals who feel or who appear to feel hopeless.
Lin, P. The Influence of Patient Preference on Depression Treatment in Primary Care. Ann Behav Med 2005, 30(2):164–173.
Participants with depression who preferred medication were older, were in worse physical health, and were more likely to already be taking antidepressants. Participants who preferred both medication and counseling evidenced greater agreement with the statement that depression is a medical illness. Matched participants demonstrated more rapid improvement in depression symptomatology than unmatched participants.
Pattyn, E. Public Stigma and Self-Stigma: Differential Association with Attitudes Toward Formal and Informal Help Seeking. Psych Services, 2014.
Respondents with higher levels of anticipated self-stigma had more negative attitudes toward seeking help from general practitioners and psychiatrists but not from non-medical specialists (psychologists). Some people seemed to fear devaluation and discrimination by their significant others. Psychoeducation of families and friends of people with mental illness would enhance the provision of lay support.
Conversation Kick Offs
- Facilitator Discussion Starter
- A Conversation with a Rural Care Provider Who Inspires
Tip Sheets, Projects & Campaigns
- Facts about Stigma and Mental Illness in Diverse Communities: National Alliance on Mental Illness (NAMI) Multicultural Action Center
- Make It OK: A campaign to reduce the stigma of mental illness. Participating organizations have pledged their commitment to change the hearts and minds about the misperceptions of mental illnesses by encouraging open conversations and education.
- Project Implicit: Translates academic research into practical applications for addressing diversity, improving decision-making, and increasing the likelihood that practices are aligned with personal and organizational values.
- Stigma & The Role of the Faith Community: Transcript from the NAMI Oregon 2003 State Conference
- Unconscious Bias: Effect of bias on medical education and patient care settings.