Integrating Primary and Behavioral Health Care Filipino American

Integrating Primary and Behavioral Health Care Filipino American Cardiovascular Health Summit July 9, 2011 Trina Dutta, MPP, MPH HHS/Substance Abuse and Mental Health Services Administration

What does the data tell us? 3 • Of those young adults who had an STD in the past year • 3. 9% used both alcohol and illicit drugs, • 3. 1% were heavy drinkers (drank 5 or more drinks on the same occasion on 5 or more days in the past month), • 2. 1% used only alcohol but no illicit drugs, • 2. 1% used only illicit drugs but no alcohol, • 1. 3% did not use alcohol or illicit drugs • Cocaine use is associated with myocardial infarction, acute myocardial ischemia, arrhythmias, sudden death, and cardiomyopathy (all exacerbated by alcohol use) • Amphetamine use causes many of the same cardiac problems as cocaine • Cardiomyopathy and arrhythmias can be caused by alcohol abuse alone • Injection drug use leads to endocarditis (inflammation of the inside lining of the heart chambers and heart valves) • Hospitalizations for endocarditis relating to injection drug use increased by 38 -66% in the US between 2001 -2002 and 2002 -2003.

What does the data tell us? 4 • 70% of Maine’s population with SMI has 1 chronic health condition, 45% have 2, and 30% have >3 (among the general population, 1/5 Americans have multiple chronic conditions) • MA Department of Mental Health (DMH): among persons 25 to 44, CVD mortality was 6. 6 x higher among DMH clients than the general population • CVD was the primary cause of death in persons with mental illness (MO, OK, RI, TX, UT, VA: average data from 1996 -2000) • Rates of smoking

What does the data tell us? 5 • Nearly 12 M visits made to hospital EDs in 2007 involved people with a mental disorder, substance abuse problem, or both (accounts for 1/8 of the 95 M visits to EDs by adults in 2007) • Of these visits, 2/3 involved those with a mental disorder, 1/4 was for those with a substance abuse problem, and the rest involved those dealing with both • Of the 12 M ED visits: • Depression and other mood disorders accounted for 43% of the visits; 26% were for anxiety disorders; 23% involved alcohol-related problems • Mental health and/or substance abuse-related visits were 2½ times more likely to result in hospital admission than visits not involving these • 41% of mental disorder and/or substance abuse-related visits resulted in hospitalization • Medicare was billed for 30% of all mental health and/or substance abuse emergency department visits; private insurance was billed for 26%; the uninsured for 21%; and Medicaid for 20%

Percentages of Asians Aged 12 or Older Reporting Past Month Cigarette Use: 20022004 6 Source: SAMHSA, 2002, 2003, and 2004 NSDUHs.

Treatment Admissions, by Race and Primary Substance of Abuse: 2002 7 Source: 2002 SAMHSA Treatment Episode Data Set (TEDS).

Percentages of Asian Youths Aged 12 to 17 Reporting Past Year Alcohol Use, by Racial/Ethnic Subgroups: Annual Averages Based on 1999 and 2000 NHSDAs 8

Percentages of Asian Youths Aged 12 to 17 Reporting "Binge" Alcohol Use, by Racial/Ethnic Subgroups: Annual Averages Based on 1999 and 2000 NHSDAs 9

10 Why is integration important?

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Technical Assistance Center: SAMHSA/HRSA Center for Integrated Health Solutions (CIHS) 13 In partnership with HHS/Health Resources and Services Administration (HRSA) • Goal: To promote the planning and development of integrated primary and behavioral health care for those with SMI, addiction disorders and/or individuals with SMI and a co-occurring substance use disorder, whether seen in specialty mental health or primary care safety net provider settings across the country • Purpose: – To serve as a national training and technical assistance center on the bidirectional integration of primary and behavioral health care and related workforce development www. centerforintegratedhealthsolutions. org

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Affordable Care Act, Section 2703 15 “State Option to Provide Health Homes for Enrollees with Chronic Conditions”* Goal: enhanced integration and coordination of primary, acute, behavioral health (mental health and substance use), and long-term services and supports for persons across the lifespan with chronic illness The health home provision provides an opportunity to build a person-centered system of care that achieves improved outcomes for beneficiaries and better services and value for State Medicaid programs *Led by Centers for Medicaid and Medicare (CMS), in partnership with SAMHSA, ASPE, HRSA, and AHRQ

Affordable Care Act, Section 2703 16 Population Served • Eligible individuals are those with chronic conditions, meaning an individual who is eligible for medical assistance under the State plan or under a waiver of such plan and has at least – 2 chronic conditions; or – 1 chronic condition and is at risk of having a second chronic condition; or – 1 serious and persistent mental health condition • Chronic conditions must include: – – A mental health condition A substance use disorder Asthma Diabetes

Affordable Care Act, Section 2703 17 Required Services • Comprehensive care management; • Care coordination and health promotion; • Comprehensive transitional care, including appropriate follow-up, from inpatient to other settings; • Patient and family support (including authorized representatives); • Referral to community and social support services, if relevant; and • Use of health information technology to link services, as feasible and appropriate.

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Substance Abuse Treatment Facility Locator 19 • Services Provided: – Substance abuse treatment – Detoxification. Methadone maintenance (facility may also use buprenorphine in maintenance) – Methadone detoxification (facility may also use buprenorphine in detoxification) – Halfway house – Buprenorphine services • Type of Care: – Outpatient – Partial hospitalization/Day treatment – Residential short-term treatment (30 days or less) – Residential long-term treatment (more than 30 days) – Hospital inpatient • Special Language Services: – ASL or other assistance for hearing impaired

Substance Abuse Treatment Facility Locator 20 • Special Programs/Groups: – Adolescents – Persons with co-occurring mental and substance abuse disorders – Persons with HIV/AIDS – Gays and lesbians – Seniors/older adults – Pregnant/postpartum women – Women/Men – Residential beds for clients' children – DUI/DWI offenders – Criminal justice clients • Forms of Payment Accepted: (NOTE: Check with facility for details. Applicability varies according to individual circumstances. ) – – – Medicaid State financed insurance (other than Medicaid) Medicare Private health insurance Military insurance (e. g. , VA, TRICARE) Self payment

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23 Thank you! Trina Dutta, MPP, MPH Trina. dutta@samhsa. hhs. gov 240 -276 -1944