Seven Recommendations from the AHA

A report from the American Hospital Association’s Task Force on Behavioral Health offers hospital leaders several recommendations on strategies they can undertake to address mental health needs in their communities. They include:

•Ensure that community health assessments include specific attention to behavioral illness.

•Review and evaluate the organization’s behavioral plan in light of identified community needs, patient needs and available community resources.

•Use a comprehensive financial and operational assessment to evaluate the benefits and value of behavioral health services to all operational components of the hospital.

•Encourage and participate in developing a communitywide plan for people with behavioral health disorders and in coordinating community agencies that address behavioral health needs.

•Work with community agencies and with state and local governments to ensure that patients are treated in the most appropriate setting so that the hospital’s backstop role is appropriately limited.

•Create a formal plan that clearly defines the hospital’s role and its established relationships for behavioral health with other providers, practitioners, and government and community agencies.

•Clearly communicate to public and private payers the costs required to care for behavioral health patients and the cost to society of not treating those patients.

The hectic, stressful nature of the typical emergency department makes it a less than ideal setting for mental health care. Nevertheless, hospital EDs have become a major component of the nation’s de facto behavioral health system.

The reasons: Years of funding cuts to public mental health organizations and the resulting loss of thousands of inpatient beds at state and county facilities, coupled with increased demand for services. Mental illness and substance abuse account for 4 percent of ED visits, or nearly 5.5 million visits a year.

The increased pressure on already overburdened emergency departments results in distracted staff, bed shortages and, too often, a worsening of mental health patients’ conditions, asserts the American College of Emergency Physicians.

Adds AHA President and CEO Rich Umbdenstock, “The other unfortunate thing is if it’s not the hospital, it’s the local jail or prison system, and that’s equally problematic.”

To address the problem, many hospitals are embarking on strategies to increase access to mental health screening and outpatient services, to improve behavioral health care within the ED, and to connect patients with medical and social services in the community.

The growth of value-based payment and accountable care makes these efforts even more imperative. “As the world moves to that type of payment system, keeping a population healthy means keeping them healthy physically, mentally and, frankly, socially,” Umbdenstock says.

Here’s a look at a handful of innovative approaches hospitals are taking to improve care and access for patients with behavioral health concerns.

CASE STUDY

Montefiore: Integrating psychiatry into primary care

At New York’s Montefiore Health System, requests by primary care physicians for help in treating patients with behavioral health issues sparked an initiative a year ago to begin embedding social workers and psychiatrists in each of its 23 primary care sites.