A Healthier Future for West Virginia - Healthy People 2010

18 - Mental Health and Mental Disorders

Objectives | References

Background

Mental illnesses affect children, adolescents, adults, and older Americans of all ethnic and racial groups, both sexes, and all educational and socioeconomic levels. No one is immune from the risk of mental illness. Approximately 40 million Americans aged 15 to 54 experience some type of mental illness each year, an estimated 8 million of whom will have both a mental illness and a substance use disorder. The chance of developing a diagnosable mental illness over the course of the life span is even higher; fully 35% of the population aged 15 to 54 will develop a mental illness at some time in their lives. The prevalence of mental illness is roughly comparable to the prevalence of many other physical illnesses and may be a coexisting condition that has an effect on the course of the physical illness.

In West Virginia, there has been significant improvement in the mental health service delivery system in recent years, even with the special challenges of a rural, sparsely populated state with high poverty levels. There has been a steady increase in the number of people served, the availability of, and the access to mental health services. Incidence and prevalence formulas published in the Federal Register estimate there are 35,099 adults (2.6% of the adult population of West Virginia) who meet the federal definition of serious mental illness. The Department of Health and Human Resources (DHHR) estimates that there are 54,847 children in the state who meet the definition of serious emotional disturbance, based on the 13% prevalence rate for the overall population.

The comprehensive community-based system of care for adults with severe, recurrent, and persistent mental illnesses emphasizes community integration and recovery. For nearly 20 years, West Virginia has sought systemic change in services to adults with mental illnesses through improvement in knowledge, skills, and attitudes regarding services and the continued promotion of local program development. The family-focused, community-based system of care for children with serious emotional disturbances has focused on implementation of an array of services with a core of four: crisis services, case management services, assessment services, and home-based family preservation services. Structures currently in place and being developed ensure interagency collaboration for children and their families.

The behavioral health delivery system in West Virginia continues to undergo dramatic change as the state prepares for managed behavioral health care. The determination of reimbursement for behavioral health services is now based on an individual's functioning level, available support system, and current clinical stability, in addition to a psychiatric diagnosis. Funding for all behavioral health services is a blending of Medicaid reimbursements, state allocations, and federal grants. The emphasis of the move toward managed behavioral health care has been to match the level of care provided to the level of need expressed and/or exhibited by the consumer. Through the collaborative efforts of families, consumers, providers, and state-level decision makers, the West Virginia mental health system will adequately address the needs of adults with mental illness and children with serious emotional disturbances.

Many consumers of mental health services utilize their primary care physician for treatment, regardless of the doctor's expertise with psychiatric illnesses or emotional disorders. The Rural Health Education Partnerships Program (RHEP) of the University System of West Virginia will be utilized to insert modules concerning mental health and its related symptomology for use within the student rotations. Students in nine disciplines complete more than 1,500 rural rotations through RHEP each year. Health sciences students are trained in more than 250 community sites including hospitals, health centers, pharmacies, and social service agencies.

Licensed physicians are required to obtain continuing education. According to the West Virginia Board of Medicine, there are currently 6,177 active licensed physicians in the state. West Virginia will provide training workshops on the signs and symptoms of behavioral health problems as well as the appropriate referral sources for these problems. This objective will apply to both primary care physicians and pediatricians. More modern assessment information and treatment practices being relayed to all doctors will allow for earlier detection of major problems and quicker interventions if necessary.

Medical students, residents, and licensed physicians will also receive training on screening for postpartum depression and whether referral to a mental health professional is necessary. Emphasis will also be placed on children's mental health, with prevention of future problems and early detection as the focus.

The following objectives will assist West Virginia in continuing to improve its behavioral health system over the next decade.

The Objectives

FLAGSHIP OBJECTIVE
OBJECTIVE 18.1. Increase the reported use of crisis services provided by community behavioral health centers by 5% each year. (Baseline: 7,103 crisis interventions estimated in 2000)

Data Sources: Client Services Data Report (CSDR) of Office of Behavioral Health Services (OBHS); pre-admission screening data from OBHS; involuntary commitment data submitted to OBHS by contract agencies

Persons with behavioral health problems frequently experience crises. The community behavioral health centers of West Virginia contract with the Department of Health and Human Resources for the provision of certain core services, one of which is crisis intervention and professional crisis response. Many people with undiagnosed mental illnesses or even current recipients of behavioral health services can benefit from proactive effective and efficient crisis services. Crisis response will reduce the length of time for stabilization of symptoms and reduce the use of other high-end services such as hospitalization. By increasing effectiveness, one can increase accessibility. This is the goal of this objective. It will be achieved through analysis of data collected and training provided to contract agencies as requested.

OBJECTIVE 18.2. Reduce the statewide suicide rate to 10.5 per 100,000 by the year 2010. (Baseline: Age-adjusted rate of 11.8 deaths per 100,000 population in 1998)

Data Source: West Virginia Bureau for Public Health (WVBPH), Office of Epidemiology and Health Promotion, Health Statistics Center

Suicide has become the focus of national attention thanks to the announcement by the U.S. Surgeon General that it is a national problem that must be addressed. In West Virginia, the rate of suicides per 100,000 population is 14.2, compared to the national average of 12.0. A Suicide Task Force established through Healthy People 2000 will be continued and will make recommendations to the appropriate decision makers on how the rate can be reduced. The areas of focus will be improved marketing of crisis services provided by community behavioral health centers, easier reference to how to access help via phone or in person, partnerships with law enforcement and school systems, and greater attempts to reduce the stigma of mental illness.

OBJECTIVE 18.3. Increase to 20% the number of individuals with serious mental illnesses who are engaged in competitive employment. (Baseline: 9.2% in 2000)

Data Source: Demographics of West Virginia Functional Assessment

There have been many recommendations to increase and enhance provider, consumer, and family member knowledge about mechanisms to move from SSI/SSDI to employment without endangering benefits. The loss of these entitlements and benefits, whether real or perceived, is a key inhibitor to persons with mental illnesses seeking employment. The recent changes in Social Security laws related to employment and maintaining benefits will be distributed and training will be held. Partnerships with local businesses and mental health providers will assist consumers in achieving their vocational goals. To establish a baseline for this process, a survey will be conducted that determines what factors inhibit consumers from seeking employment for those not working. A similar survey will be completed with consumers who are employed to determine how they successfully overcame the barriers.

OBJECTIVE 18.4. Decrease by 10% per year the number of persons with mental illness who are jailed due to minor offenses as a result of their psychiatric conditions. (Baseline: 543 persons in 2000)

Data Sources: Pre-admission screening data of OBHS; Bureau for Justice Statistics web page; inmate demographic data from State Department of Corrections; number of graduates of State Police Academy; number of hours of training designated in training curriculum

People with mental illnesses are frequently arrested (usually for minor crimes). Community behavioral health center staff can play an important role in diverting such individuals from inappropriate incarceration and/or achieve continuity of treatment when an individual has been arrested. Several model police mental health intervention programs have been implemented in the United States. West Virginia will increase the amount of training in mental health issues received by graduates of the West Virginia State Police Academy from 4 hours to 40 hours for 100% of its graduates. Partnerships between law enforcement and mental health professionals are a definite possibility and will help alleviate some of the burdens on both the criminal justice and behavioral health systems. This will ensure individuals are referred to the best and most appropriate level of intervention to protect the public and meet their treatment needs.

OBJECTIVE 18.5. Increase to 11 the number of specialized Mentally Ill and Chemical Addiction (MICA) programs for dually diagnosed consumers. (Baseline: 1 in 2000)

Data Sources: Number of dual diagnosis programs in West Virginia; admission data from state hospitals showing rate of hospitalization for MICA consumers discharged from specialized programs compared to the number of hospitalizations before their existence.

Comorbidity of mental and addictive disorders is not uncommon. Among those with an alcohol disorder, 37% also experience a mental illness; among those with other drug disorders, 53% experience a mental illness. Schizophrenia is four times more likely to have a co-occurring substance issue, and anxiety and depressive disorders are twice as likely in people with alcohol disorders. Studies have found that the vast majority (79%) of lifetime mental illnesses appear to be comorbid illnesses. The data suggest that the major economic and social burdens of psychiatric disorders in our society are likely concentrated in those who experience significant comorbidity.

Co-occurring mental and addictive disorders also are found among children and adolescents. Externalizing disorders among children and adolescents—more prevalent in males—such as oppositional defiant disorder, conduct problems, and ADHD, appear to be strongly related to similarly externalizing adolescent behaviors such as alcohol use, violence, and delinquency.

As in national studies, the majority of persons who are classified as recidivists in the mental health system of West Virginia have both a mental illness and a substance abuse problem. Substance Abuse Block Grant funds and Community Mental Health Services Block Grant funds have been permitted to be blended for addressing the needs of this population. There is currently one dual diagnosis program in West Virginia. This approach, as well as assertive community treatment, will be replicated in other areas of the state. The initial focus of treatment and approaches have differed in the past, but newer research has given a standard method for treating both issues simultaneously. West Virginia will assure that all behavioral health providers are trained and use the newer methods of treatment to improve outcomes and reduce recidivism.

OBJECTIVE 18.6. (Developmental) Seventy-five percent (75%) of adults with serious mental illness, 75% of children with serious emotional disturbances, 75% of the families of adults with mental illnesses, and 75% of the parents of children with serious emotional disturbances will rate the quality and appropriateness of care positively by the end of year one, and this approval rate will increase by 2% annually. (Baseline data available in FY2000)

Data Sources: Satisfaction surveys from West Virginia Mental Health Consumers Association, National Alliance for the Mentally Ill (NAMI) West Virginia, and Mountain State Parents, Children and Adolescent Network

Satisfied customers are happy customers. This has long been known in the business field and has also become important in the helping fields in recent years. One manner in which to tell if one's customers or consumers are happy is through a satisfaction survey. The West Virginia Mental Health Consumers Association has completed primary consumer satisfaction surveys for the past three years and will continue to do so in the future. NAMI West Virginia has developed a family satisfaction survey and it will measure the level of satisfaction families have with the services provided to their ill family members. The Mountain State Parents, Children and Adolescent Network has developed an instrument that measures both child and parent satisfaction. This survey is in its second year and will also be continued. These objectives are also utilized in the Community Mental Health Services Block Grant to assure that the behavioral health system is providing good services to the residents of West Virginia and they are pleased with the outcomes.

These six objectives will assist the mental health system in moving forward into the new millennium. They allow standards for planning and organizing how the West Virginia Department of Health and Human Resources will assure the delivery of quality and effective services to those persons with mental illnesses and those children with emotional disturbances.

Meeting the Objectives

Health Promotion Channels for Achieving Objectives:

• Worksites
• Schools
• Public Health Programs
• Networks
• Health Care System
• Higher Education

The lead entity for meeting these objectives will be the Office of Behavioral Health Services. Other groups associated will include: West Virginia Mental Health Consumers Association, NAMI West Virginia, Mountain State Parents, Children and Adolescent Network, and the West Virginia Behavioral Healthcare Providers Association.

Work Group Members

Rick Coffinbarger, Work Group Leader, Quality Control Manager, Office of Behavioral Health Services, DHHR
John Bianconi, Director, Office of Behavioral
Health Services, DHHR
Henry Marockie, Superintendent, Department
of Education
Ken Selbe, Office of Maternal, Child & Family
Health, WVBPH
Tom Sims, Director, Division of Health Promotion, WVBPH
John Russell, Executive Director, WV Behavioral Healthcare Providers
Association
Elizabeth McCullough, President, NAMI West Virginia
Teri Toothman, Executive Director, Mountain State Parents, Children and Adolescents Network
Larry Belcher, Executive Director, WV Mental Health Consumers Association
Joe Degan, Thomas Memorial Hospital
Alicia Tyler, Central Office for College and University Systems of West
Virginia
Ronald Walton, Executive Director, West Virginia Board of Medicine
Diana Boyle, Board of Examiners for Registered Professional Nurses
Lanette Anderson, Board of Examiners for Licensed Practical Nurses
Judy Williams, Director, Board of Social Work Examiners
Jean Johnson, Program Specialist, Board of Examiners in Counseling
Charlotte Thurston, Administrative Assistant, Board of Examiners of Psychologists
Lolita Crews, Vice-Chair, West Virginia Mental Health Planning Council

References/Resources

Behavioral Health Committee of Governor's Cabinet Council on Health and Human Resources. October 1998.

Memphis Police Crisis Intervention Team and Albuquerque Police Crisis Intervention Team. CIT - More than Just Training. 1997 NAMI Convention.

Office of Behavioral Health Services. Consumer Service data report.

Office of Behavioral Health Services. West Virginia Functional Assessment Instrument data.

West Virginia's Community Mental Health Services Block Grant Application, submitted to the Center for Mental Health Services, August 1998.

www.cdc.gov/ncipc/osp/leadcaus/wvtable.htm

www.nimh.nih.gov/research/suifact.htm

www.rochford.org/suicide/resource/stats/us

http://www.wvdhhr.org/bph/oehp/vital98/index.htm

For More Information

Office of Behavioral Health Services
350 Capitol Street, Room 350
Charleston, WV 25301-3702
Phone: (304) 558-0627; Fax: (304) 558-1008

This page was last updated June 27, 2001.
For additional information about HP2010, contact Chuck Thayer at (304) 558-0644 or Chuck.E.Thayer@wv.gov