Meeting Minutes - Executive overview
Work Group Binder: Information includes the PHIP fact sheet, mental health data, the NYS Prevention Agenda Action Plan, an overview of the Finger Lakes Health Systems Agency and articles on evidence based best practices for mental health literacy, stigma, housing and the built environment and transportation.
Work Group Charter: The work group charter explains the roles and responsibilities of the members, board of directors, MV PHIP staff, consultants (HCI) and technical experts (BEST). Work group members may recommend revisions.
Work Group Open Discussion: Topics mentioned were:
1. Stigma
2. Adequate care and services for those on waiting lists
3. Understanding mental health and recognizing warning signs
4. Number of providers in the region
5. Resources being available in multiple languages (for example, Spanish)
6. Increased occurrence of child behavior issues
7. Limited access to mental health assessments for providers
A discussion occurs on programs and interventions. Topics included:
1. Children meeting with a school psychologist or counselor at lunch to reduce stigma
2. Policy change to bi-directionally share records under the mental hygiene law
3. Improving mental health services and increasing the of number providers in school systems
4. Public health messages that reduce stigma
5. Publicizing mental health resources within a community
6. Mental Health First Aid training to address number 3 listed above. Policy change: make it a requirement for school systems
7. Advocacy with elected officials
8. Pediatricians and physicians to promote/distribute local mental health resources
9. Coping skills toolkit to serve as a preventative measure
10. Contracting with other organizations to provide services in schools
Mohawk Valley PHIP
December 22, 2015
Access to Mental Health Work Group Minutes
Stakeholders: Lori Kinch-Ashley (Catskill Area Hospice & Palliative Care); Scott Friedlander (St. Mary’s Healthcare), John Nasso (Catholic Charities); Julie Dostal, PhD (LEAF, Inc.); Breelynd Eggleston (Herkimer ARC); Debi Crisalli (Montgomery Public Health); Kristin Pullyblank (RHENSOM); Bri Giulianelli (St. Mary’s Healthcare), Robin DeVito (Fulton Montgomery Community College); Angelika Klapputh (Red Cross); Lisa Volo (Regional Primary Care Network); David Jordan (Montgomery Office for the Aging); James B. Anderson, PhD (Bassett DSRIP); Amy Gildemeister, PhD (Schoharie Dept. of Health); Bonnie Post (Schoharie Office of Community Services); Melinda McDuffee (NAMI-MFH); Sister Christine Mura (St. Mary’s Healthcare); Denis Wilson (Fulmont Community Action Agency, Inc.) and Moira Riley, PhD (Bassett Research Institute)
Staff: John May, MD, Aletha Sprague, Anna Gleboff, Bonita Gibb, and Felicia Johnson
Welcome & Introductions:
Ms. Sprague welcomes attendees and members introduce themselves. Ms. Sprague then introduces Ms. Gibb to review the work group materials.
Work Group Structure:
Ms. Gibb reviews the fact sheet, work group charter, existing mental health data, NYS Prevention Agenda’s Promote Mental Health and Prevent Substance Abuse Action Plan and an overview of the Finger Lakes Health Systems Agency (the model for the PHIPs) and their recommendations for promoting mental health. Ms. Gibb also conducted a literature review and included articles on evidence based best practices for mental health literacy, stigma, housing, the built environment and transportation.
Ms. Sprague asks attendees to review the work group charter. The charter outlines the roles and responsibilities of the work group members and the MV PHIP Staff. She comments that this is a draft document open for member feedback and modification and serves as a resource for new members. She reminds the group of their mission: “All New Yorkers should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of where they live, their income, education, or background.” The MV PHIP tries to identify and eliminate health disparities by promoting CLAS standards. She goes on to say we are trying to get representation from multiple sectors and counties. Depending on the selected intervention, we may recruit organizations who are directly involved. For example, if the work group chooses to approach housing, we would want to contact such individuals as county developers and housing authorities. At any time, if any member thinks of an organization that should be involved, group members are welcomed to invite them or ask the MV PHIP to reach out.
Ms. Sprague elicits feedback on the work group charter. Mr. Nasso asks for clarification on the phrase, “To make the choices” in the mission statement. Ms. Sprague replies that we want to make the healthy choice the easy choice or the default option for people. For example, some in our region live in food deserts where access to healthy food is not easily available. Mr. Nasso responds that this will lead people to make better decisions that will help them live healthier lives. Dr. Dostal comments that charter describes the group structure but not the group process. She asks if the ultimate goal is to make access to mental health easier for people and if there is a strategic plan in place. Ms. Sprague responds that strategic plan will be determined by the work group.
MV PHIP would like a co-chair to assist with facilitating the meetings and represent the work group at board meetings. The work group will also decide the structure and meeting schedule. The work groups will meet at a minimum of every other month, or six times per year. A pad of paper was sent around the room for chair nominations. Dr. May suggests dividing the role of the chair into a rotating position. Ms. Sprague adds that the MV PHIP would be responsible for securing the meeting space, the meeting minutes and data and information support. Ms. Sprague goes on to talk about data requests. The MV PHIP is responsible for providing data to the work groups. She informs the group when asking for mental health data; please specify the indicators, so the MV PHIP can make a request to the NYS Office of Mental Health or OASAS. Other data will be accessible from the upcoming MV PHIP website. The MV PHIP contracted with Healthy Communities Institute (HCI) to make data accessible to the community at the county and zip code level.
Open Discussion:
Dr. May states for the remainder of the meeting the group should discuss where they would like to have the work group heading by sorting out the priority issues and interventions based on the NYS Prevention Agenda. He goes on to say that the MV PHIP would look for grant opportunities and/or begin seeking funding. Let’s talk about the process of how we would get to that point. He brings up four discussion points.
1. Are substance abuse and mental health tightly linked and is this an issue if they are not?
2. What are the major barriers to access for mental health?
3. What barriers are the top priorities, most feasible and easiest to impact?
4. How do you see getting this group to the point where we are ready to put some type of intervention in place?
All of these decisions are up to the work group.
Mr. Nasso starts the conversation by saying that he read the minutes from the stakeholder meeting and stigma was mentioned as a barrier. He goes on to say that stigma exists but he doesn’t know if it keeps a large number of people away from services. He adds Fulton County has two mental health resident programs and some people utilize the system for decades. Dr. Anderson replies he thinks that stigma does prevent some people from accessing services, but with the current system they struggle to get people already seeking services help. Dr. Anderson goes to say that the work group should figure out a way to help with the backlog of individuals before identifying more people. Dr. Gildemeister responds that she agrees with Dr. Anderson, but says with this particular work group they are supposed to use population based and NYS Prevention Agenda interventions. She goes on to say that addressing stigma speaks to the issue of trying to help people before a crisis situation. Ms. Sprague reminds the work group that population health interventions are policy, system, and environment changes. Dr. Gildemeister adds that the work group is trying to make the default choices be the healthy choices. She describes a conversation she had with Ms. Post inquiring about programs for public school age children in Schoharie County and she learned that very little exists except for some substance abuse education programs. In the private school Dr. Gildemeister’s daughter attends, the children meet as a group with the school psychologist during lunch every second week to establish a relationship and reduce stigma.
Ms. DeVito replies that she thinks that public schools could have a similar program. Dr. Gildemeister comments that the kids love it. Ms. DeVito raises another point of devaluing of mental health services and providers. She states when budget cuts occur, the first to go are the counselors. After all of the college campus shootings, in response there is a quota for mental health providers to students. NY has data reflecting how far off they are from the quota. Ms. DeVito goes on to say that at FMCC, when the psychologist retired, they did not replace this position. She says she doesn’t know if has to do with the lack of availability of counselors or if it is funding. She states that when the college had preventative services and counselors available they caught issues before they escalated. Fewer calls were made for ambulances and ER care for crisis situations, which increases cost.
Dr. Anderson discusses the competing principles of reducing stigma and privacy protection. He says on one hand we want to reduce stigma and on the other hand we have professional ethics and state laws that silo care in the name of privacy. We emphasize privacy so much that leads to stigma. He says, “You have to go to this secret place, with secret records to get this secret service so of course that is going to create stigma. I am an advocate for bi-directionally shared records designed to help break down the stigma.”
Ms. Klapputh wonders if there is a preventative public health message that can be rolled out population wide which would address stigma and also in an ideal case, lower the incidence of mental health crisis and ultimately, lower the patient load of the provider.
Dr. Dostal comments that LEAF recently analyzed data collected from 300 respondent parent surveys in Otsego County and comprised a broad sample. Participants were asked if they knew how to access substance abuse and mental health services for their children if they needed them. Only 30% of the participants responded that they were confident or very confident accessing services. Dr. Dostal comments that it is troubling percentage. Mr. Jordan replies he believes that people wait until there is a crisis to learn about services and that parents will look up services if their child is in need. Dr. Dostal responds that the data did not reflect that idea and she recommends the group educate the public about available mental health services combined with stigma reduction. Ms. Volo comments she is a mental health first aid instructor. Mental health first aid is an eight hour certification program designed to prevent stigma and to identify the early warning signs of certain types of mental health conditions. It is a CPR equivalent and it is evidence based.
Mr. Friedlander states he agrees with a comment Mr. Nasso made at the beginning of the discussion and goes on to say that the persistently mentally ill do receive the services they need. The work group should target children and the working class. Mr. Nasso asks if the group is going to target the high users of Medicaid and those already being served, such as the chronically mentally ill, or is it the younger people through stigma reduction. Services for children are limited in Fulton and Montgomery counties and there are long waiting lists. He goes on to say they would like to educate children to tell someone if they have a problem but he has concerns about the wait list. Mr. Friedlander replies that children could start by talking with their pediatricians. Ms. Eggleston states in Herkimer County there is a shortage of providers accepting Medicaid. There may be services in Utica, or in other larger cities but transportation is an issue.
Dr. Dostal comments access to mental health services does not fit with the NYS Prevention Agenda or population based health since the focus isn’t on prevention. We are talking about access, which means that people already have those issues. She says it will be difficult to talk about universal prevention, or population level prevention, when we are talking about somebody who is already exhibiting symptoms of a disorder. Dr. Gildemeister agrees with Dr. Dostal and states that DSRIP focuses on the Medicaid population, so she wonders how this group will tackle the topic.
Dr. May responds Dr. Dostal raises a good point and there’s not a doubt that DSRIP focuses on the Medicaid population. He asks the group to refer back to the social determinants of health where 20% of the population depends on the delivery of care, the professionalism and skill of the practitioners, etc. that is what DSRIP is focused on with some population health. PHIP will be paying attention to the other 80%. Dr. May continues by saying if the group focuses on the health environment and health behaviors, then we are doing what we are supposed to be doing. Ms. Sprague comments the access to mental health was chosen by the board and stakeholders, but the work group could modify the focus to promotion and prevention.