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VAHHS Members Discuss Mental Health System Challenges

September 30, 2017

It's Mental Health Awareness Week, when the National Alliance on Mental Illness and participants across the country work to raise awareness and advocate for the best possible care. VAHHS is continually working with members and other groups to help address all dimensions of mental illness – from treatment of patients in the emergency department to ensuring optimal community-based care.

At the recent VAHHS Annual Meeting, Steve Gordon, CEO of Brattleboro Memorial Hospital, moderated an expert panel on the mental health challenges facing our state. Panelists included Kathryn Power, M.Ed., Regional Administrator of Substance Abuse and Mental Health Services Administration (SAMSHA); Melissa Bailey, Commissioner of the Vermont Department of Mental Health; Dr. Mark McGee, Chief Medical Officer at the Brattleboro Retreat; and Dr. Brett Rusch, Chief of Staff at the VA Medical Center.

Panelists discussed a range of issues facing Vermont's mental health system – and potential opportunities like telemedicine to improve access. 

Power reported disruptive innovation in three areas:

  • Technological advances
  • Social change innovation, and
  • Policy forces

She pointed out evolution in the field of pediatric mental health care.

“It used to be that people with mental illness never had primary care in the same system. Now early assessment (by pediatricians) can lead to options of better diagnoses and intervention. We can be more holistic, taking into account mind and body,” she explained.

She remarked that many mental health conditions occur in children as young as 9- to 13-years old, noting that health care providers need to assess children for trauma early.

“It’s no different from anything else,” she said. “We need to normalize it—ask me about my trauma.”

Power also discussed the need for assessing other social determinants of a patients’ conditions.

“Patients can get stuck. There could be housing issues, transportation issues that become obstacles to  getting a next level of care,” she noted, offering that many psychiatric patients are seen in the emergency department 

“It’s important to develop a mobile treatment plan, a regular psychiatric work plan before discharging a patient from the ED,” she said.

Rusch echoed the need for mobile treatment plans, noting that veterans need to be able to get mental health substance abuse care outside of VA facilities.

“That’s the way we would build the system if we built it today,” he said. “Veterans would be able to get VA care wherever they were.”

Panelists discussed medical school curriculum and its effect on the mental health system. Power stated that to find solutions to the nation’s opiate crisis, dentists and pharmacists need to study addiction.

“They need to have a holistic view about mental health,” she posited.

McGee remarked that telemedicine has helped the Brattleboro Retreat improve access for patients, especially to specialists like psychiatrists who are in great demand in Vermont. To make using the technology easier, he suggested making it easier for providers to practice across state lines.

“We need to streamline the licensing and credentialing process. It takes eight to 12 weeks to get licensed now. National licensure could help us build a dynamic economy and workforce,” he said. 

All panel members decried the fact that stigma still plagues mental health patients.

“At SAMSHA, we refuse to use the word ‘stigma’,” Power said, explaining that staff find other ways of describing what patients are feeling—“fear” or “loss of dignity.”

“The word ‘stigma’ itself is stigmatizing. We can’t truly address the needs of a person if we’re using that language.”

McGee noted that even many health care providers have a lack of knowledge about the field of mental health.

“They make a false separation between the brain and the rest of the body. I think it’s the role of education, of medical schools, to teach skills in psychology the same as any other skills.,” he suggested, noting that such skills would help doctors to be more compassionate.

“It would be eye-opening for them. It would be an opportunity to bend the trajectory of ‘empathy fatigue’ with useful and powerful tools,” he explained.

Baily charged the group to help move the mental health system forward.

“We can do three things simultaneously,’ she remarked. “Take small steps focused on our mission, make experimental leaps and take giant strides into forever changing the system. New England states have stayed progressive about health care reform and they’re wonderful partners,” she said. “We need to keep the faith and stay the course.”