Recovery and Rehabilitation of the Client with Psychosis: Friday, October 29, 2004
Evidence-based Practices
Achieving the Promise:
Transforming Mental Health Care in VA
Frances M. Murphy, M.D., M.P.H.
Deputy Under Secretary for Health for Health Policy Coordination
October 29, 2004
Wisdom of the Greeks
• Plato said,
“The greatest mistake
in the treatment of
disease is that there
are physicians for the
body and physicians
for the soul, although
the two can not be
separated.”
President’s New Freedom Commission
on Mental Health
Overview
• President’s Commission Vision and Goals
• Principles of Transformation
• VHA Mental Health Action Agenda
• What are the next steps?
• What is the price of this New Freedom?
Mental Illness Research, Education and Clinical Center, MIRECC
VA Desert Pacific Healthcare Network 1
Recovery and Rehabilitation of the Client with Psychosis: Friday, October 29, 2004
Evidence-based Practices
President’s New Freedom Commission
on Mental Health
VISION
IT’S A FUTURE IN WHICH:
• Everyone with mental illness will recover
• Mental illness can be---
• Prevented or cured
• Detected early
• Everyone with mental illness has access to effective
treatment and supports- essential for living, working,
learning, and participating fully in the community
President’s New Freedom Commission
on Mental Health
President’s Commission Goals
Goal 1: Americans Understand that Mental Health Is Essential to
Overall Health
Goal 2: Mental Health Care is Consumer and Family Driven
Goal 3: Disparities in Mental Health Services are Eliminated
Goal 4: Early Mental Health Screening , Assessment, and Referral to
Services are Common Practice
Goal 5: Excellent Mental Health Care is Delivered and Research is
Accelerated
Goal 6: Technology is Used to Access Mental Health Care and
Information
President’s New Freedom Commission
on Mental Health
• Principles of Transformation
• Treat Mental Health with the same
seriousness as General Health
• Collaborative Care
• Veteran and Family-Centered
• It Takes a Whole Community!
• Best Science to Best Services
• Recovery (Positive Individual Outcomes)
Mental Illness Research, Education and Clinical Center, MIRECC
VA Desert Pacific Healthcare Network 2
Recovery and Rehabilitation of the Client with Psychosis: Friday, October 29, 2004
Evidence-based Practices
What is Recovery?
• Recovery is a journey of self-healing
• Recovery is re-claiming a positive sense of self
despite the challenges of a mental illness
• Recovery is actively managing one’s life and
health, in order to control psychiatric symptoms,
create a positive life style and achieve higher
levels of wellness.
• Recovery is reclaiming roles and a life beyond
being a consumer of the mental health system.
“Pathways to Recovery”: Ridgeway P, McDiarmid, Davidson L et al. Data
Reproductions Corporation, Auburn Hills, MI, July 2002
Recovery Programs
• Assertive Community Treatment
• Supported Employment
• Family psychoeducation
• Integrated treatment of mental illness and
co-occurring substance abuse
• Peer support
Recovery model
emphasizes
destigmatization
and return of
each veteran to an
optimal level
of functional
capability
President’s
New Freedom
Commission on
Mental Health
Goal 1 Americans Understand that Mental
Health Is Essential to Overall Health
Goal 2 Mental Health Care Is Consumer
and Family Driven
Goal 3 Disparities in Mental Health
Services Are Eliminated
Goal 4 Early Mental Health Screening,
Assessment, and Referral to Services Equity in veterans’ mental
Are Common Practice
health care ensured to reduce
Goal 5 Excellent Mental Health Care Is
Delivered and Research Is Accelerated
Principles variability and gaps
Goal 6 Technology is Used to Access Mental
• Reduce stigma in care, including substance
Health Care
Integration of medical and mental abuse treatment programs.
Located at : [Link] health care ensures coordinated, • Promote recovery
comprehensive care, treating • Ensure equal access and reduced
veterans’ mental disorders with the
same urgency as medical
variability of care
disorders. • Provide culturally competent care to
veterans of all ages, races, ethnic
groups and genders
• Be veteran and family centered
• Employ evidence-based population
approaches
Mental Illness Research, Education and Clinical Center, MIRECC
VA Desert Pacific Healthcare Network 3
Recovery and Rehabilitation of the Client with Psychosis: Friday, October 29, 2004
Evidence-based Practices
Veterans and Mental Health
• More than 1 in 5 veterans utilize specialized mental
health services
• Studies have estimated that 22-29% of veterans suffer
from substance use disorders.
• 2000-2010: Veterans aged 85 years will increase from
half million to 1.3 million.
• Aging veterans will need behavioral health care capacity that is
not available
Why is this important?
• Suicide is the Leading Cause of Violent
Deaths Worldwide (Source: WHO, 2002)
Homicide War-related
32% deaths
19%
Suicide
49%
Causes of Disability
(U.S., Canada,& W. Europe in 2000: SOURCE: World Health Organization, 2001)
Mental Illnesses
Alcohol and Drug Use Disorders
Alzheimer’s Disease and Dementias
Musculoskeletal Diseases
Respiratory Diseases
Cardiovascular Diseases
Sense Organ Diseases
Injuries (Disabling)
Digestive Diseases
Communicable Diseases
Cancer (Malignant neoplasms)
Diabetes
Migraine
All Other Causes of Disability
0% 4% 8% 12% 16% 20% 24%
Mental Illness Research, Education and Clinical Center, MIRECC
VA Desert Pacific Healthcare Network 4
Recovery and Rehabilitation of the Client with Psychosis: Friday, October 29, 2004
Evidence-based Practices
Four Obstacles
Preventing veterans with SMI or SUD from receiving care
• Variability and gaps in care for veterans with
mental illness
• Reduction of VA substance abuse treatment
programs
• Lack of a national plan implemented for
consistent provision of a full continuum of care
and supportive services
• Lack of involvement and input of Mental health
leadership into decisions that affect the care of
veterans
Transforming Veterans’ MH Care
Goal 1: Americans Understand that Mental Health is Essential
to Overall Health
• Produce a MH strategic plan and VISN plans
• Create a VA National MH Campaign
• Iraqi Freedom and Enduring Freedom
• Encourage help-
help-seeking and promote recovery
• Implement a National Strategy for Suicide Prevention
• Eliminate variability in access by 2008
• Develop collaborative care in primary care clinics
Transforming Veterans’ MH Care
Goal 2: Mental Health Services are Veterans and Family Driven
• Develop an VISTA/CPRS treatment planning tool
• Include veterans in development of their individualized
treatment plans
• Involve families and veterans in education on Recovery
• Include veterans and families on VAMC MH Councils
• Develop Peer Support Programs and a “How To” manual
• Implement Supported Employment
• Develop Advance Directives for every veteran with SMI
• Reduce use of seclusion and restraint
Mental Illness Research, Education and Clinical Center, MIRECC
VA Desert Pacific Healthcare Network 5
Recovery and Rehabilitation of the Client with Psychosis: Friday, October 29, 2004
Evidence-based Practices
Transforming Veterans’ MH Care
Goal 3: Disparities in Mental Health Services are Eliminated
• Address disparities in access, availability,
quality, and outcomes
• Recruit and train a culturally competent
workforce
• Support VA research on minority mental health
care
• Strengthen rural workforce capacity to deliver
evidence based care
• Develop rural mental health plan
• Identify national, state, local partners
Transforming Veterans’ MH Care
Goal 4 : Early Mental Health Screening, Assessment, and
Referral to Services are Common Practice
• Ensure systematic screening for mental
health and substance abuse problems in
all settings
• Require cross-training for mental health
and substance abuse providers
• Identify and implement best practices for
co-occurring disorders
Transforming Veterans’ MH Care
Goal 5: Excellent Mental Health Care is Delivered
and Research is Accelerated
• Convene an EBP Steering Committee to focus
on recovery and rehabilitation
• Develop a research agenda for prevention and
early intervention for acutely traumatized
veterans
• Establish a CSP Center of Excellence in Mental
Health
• Create a Mental Health Liaison position in ORD
• Develop a knowledge management system
• Implement QUERI priorities
• Strengthen MH training for Primary Care
Mental Illness Research, Education and Clinical Center, MIRECC
VA Desert Pacific Healthcare Network 6
Recovery and Rehabilitation of the Client with Psychosis: Friday, October 29, 2004
Evidence-based Practices
Transforming Veterans’ MH Care
Goal 6: Technology is Used to Access Mental Health Care and
Information
• VISNs should develop a Telemental Health
needs assessment and plan
• Monitor outcomes in Telemental Health
• Develop better Workload capture
• Develop an electronic treatment planning tool
• Modify VISTA/CPRS to optimize mental health
functionality
• Develop My HealtheVet to better serve veterans
with SMI and substance use disorders
Where Do We Go From Here?
Achieving the Promise for Veterans
• Implement the Plan
• Facilitate the work of the MH Action Agenda
Steering Committee
• Collaborate with State governments to develop a
State Plan for Mental Health
• Develop VA-adapted Recovery implementation tools,
“How To” manual, and educate staff.
• Implement Veteran and Family Centered care
programs at all VAMCs by the beginning of FY2005.
• Endorse Collaborative Care as a model for
integration of geriatric and mental health services in
VA primary care.
Mental Illness Research, Education and Clinical Center, MIRECC
VA Desert Pacific Healthcare Network 7
Recovery and Rehabilitation of the Client with Psychosis: Friday, October 29, 2004
Evidence-based Practices
Achieving the Promise for Veterans
• Develop a Knowledge Management System to keep staff
apprised of best practices and research.
• Develop Cultural Competence Training for all staff
• Adopt the Action Agenda regarding Workforce
Development for mental health staff
• Develop a MH research strategic plan that supports VA
recovery based mental health and translational
research programs
• Establish a VA National Mental Health Campaign
• Partner with SAMHSA on the Federal Interagency Action
Agenda
What is the Price of this
New Freedom?
The Four C’s of Transformation
• Complex Challenges Require
Systematic Solutions
• Culture Change is Critical
• Community: Everyone is
Responsible for
Transformation
• Communication,
Communication,
Communication
“We must be the change we wish to see in
the world.” - Ghandi
Mental Illness Research, Education and Clinical Center, MIRECC
VA Desert Pacific Healthcare Network 8