Experts: Population health needs to address mental health
On the rise: depression, anxiety, substance use
EXECUTIVE SUMMARY
White, middle-aged Americans have an increasing mortality rate due to behavioral and mental health issues, demonstrating the need for population health to address behavioral health.
- • Case managers can treat the whole person, including behavioral health problems.
- • A first step is to have a positive attitude about identifying mental health issues.
- • Although finding mental and behavioral health treatment services is challenging, it’s a task at which CMs can succeed.
Researchers recently made a startling discovery: White, middle-aged Americans have a higher mortality rate now than they have in previous generations. This group includes non-Hispanic men and women between 1999 and 2013. The study found that their rising death rate could be largely accounted for by drug and alcohol poisonings, suicide, chronic liver diseases, and cirrhosis.1
For case managers and others who work with this population, the findings confirm their anecdotal evidence that behavioral and mental health issues are a major comorbidity with middle-aged and older patients.
“We need population health that focuses on the whole person and the multiple complexities the person might have,” says Monica Cooke, MA, RNC, CPHQ, CPHRM, FASHRM, chief executive officer of Quality Plus Solutions in Annapolis, MD.
These complexities include depression, anxiety, substance use, and other behavioral-mental health issues, she adds.
“We refer to it as complex case management,” says Cheri Lattimer, RN, BSN, executive director of the Case Management Society of America in Little Rock, AR.
Case managers treat the whole person, and this includes behavioral health, she adds.
“I know of no patients who say, ‘I’m here for my medical,’ or ‘I’m here for my behavioral.’”
Patients often are dealing with depression, and that has to be part of the equation, she says.
Addressing behavioral health is a challenge for case managers because community resources are few and far between, Cooke notes.
“It will be many years before we as a nation build up the behavioral and mental health services this society needs,” she adds. “Nothing will change dramatically in the next 10 years, but if we center help around the population, then we need to include behavioral health.”
Case managers need to do a little research to find the community resources that patients might need and then link them to the service, Cooke suggests.
A first step is to acknowledge the effect and importance of behavioral healthcare, she says.
Patients who receive treatment for mental health and substance use issues will become healthier and feel better, Cooke says.
When CMs have a positive attitude about behavioral health services, so will their patients, she notes.
“Case managers’ role is to link a person to these services and to get them the levels of care they need,” she says.
True, it’s an additional workload for CMs, and there is no easy access to behavioral health services, so it will require multiple phone calls, Cooke says.
“It’s not like scheduling an eye exam — it’s not that simple,” she adds.
About one out of four inpatient community hospitals in the U.S. has an inpatient psychiatric unit, Cooke notes.
This suggests a needs gap as research has shown that people with comorbid medical and mental health diagnoses are admitted to the hospital from the emergency department at twice the rate of patients who do not have a mental health diagnosis.2
This gap in need versus availability of services creates a situation where many psychiatric services and beds are limited and often have long waiting lists.
“And then they have to convince the person to accept the care because no one wants to think they’re depressed or have an anxiety disorder or are psychotic,” Cooke says.
Patients with a comorbid psychiatric condition can be a lot of work for a case manager who likely already has a huge caseload, but the need for CM services is there, Cooke says.
Case managers need to facilitate mental healthcare and evaluate every patient for a mental health comorbidity, she adds. “There are plenty of tools out there to screen patients and ask questions and see where they are in terms of mental health.”
REFERENCES
- Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci. 2015, Nov. 2. Epub ahead of print.
- Emergency department visits by patients with mental health disorders — North Carolina, 2008-2010. MMWR. June 14, 2013;62(23):469-472.
White, middle-aged Americans have an increasing mortality rate due to behavioral and mental health issues, demonstrating the need for population health to address behavioral health.
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