Background:
The US is currently experiencing a Mental and Behavioral Health (MBH) crises with projections suggesting increasing prevalence rates. Access to MBH care is lower than for other types of care but especially so compared with other chronic conditions. MBH problems result in a unique situation in which the disorder itself impairs one’s ability to seek out and successfully manage treatment yet it has the fewest number of patients receiving care coordination or navigation, the longest delays between diagnosis and treatment, and the most limited follow-up. Like many other medical conditions, screening, early detection, and effective and ongoing treatment, often through care coordination, can have a profound impact on one’s quality and quantity of life—all while reducing overall health care cost; however, this is not occurring with MBH.
Wicked Problem Description:
Our hospital’s catchment area in Southeast Washington, DC represents one of the most disadvantaged in the nation, yet just a few miles away there are some of the nation’s wealthiest communities. This area is also designated as a medical underserved area and a mental health professional shortage area. This is especially unfortunate because there is evidence that common mental disorders such as depression and anxiety are distributed according to a gradient of economic disadvantage across society and the poor and disadvantaged, like the individuals living in this community, suffer disproportionately from common mental disorders and their adverse consequences. Furthermore, vulnerable and marginalized communities are less likely to receive the effective treatments that are available for MBH problems and if they do, their efficacy is often reduced due to a lack of attention to social determinants.
Project Strategies:
Our MHI-STREET program will be designed to address MBH at the patient, provider, and population health levels. We will also focus on wellness as a means to reduce the likelihood of a negative trajectory for those not in crises or otherwise stabilized in care.
- At the patient level, MBH will be addressed by introducing a mental health navigator to support mental health and social determinants of health (SDH) screening and increase patient engagement in MBH services.
- At the provider level, MBH will be addressed by educating Southeast DC primary care providers (physicians, nurses, allied health) on mental health literacy, referral to treatment, and crisis management.
- At the community level, we will work through the Ward 8 Health Council, creating a MBH Subcommittee to form inter-sectoral collaborations to address SDH and provide Mental Health First AID training to community members.
Outcomes:
To improve screening, identification, and treatment of patients with MBH disorders, to reduce stigma related to MBH disorders in the community, and to increase the opportunities for wellness in the community to help prevent MBH crises.
Timeline:
YEAR ONE: Hire and train a mental health navigator, begin MBH screening and referral on the mobile van and primary care setting; collect baseline data on patients using screening tools; create the MBH Subcommittee on the Ward 8 Health Council; and identify all primary care providers in Ward 8.
YEAR TWO: Provide mental health education in Southeast DC for primary care providers (including motivational interviewing and SBIRT) and community members (Mental Health First AID); Work with the Ward 8 MBH subcommittee members to develop more effective and sustainable ways to approach SDH of MBH.
YEAR THREE: Implement social marketing campaign to destigmatize MBH in Southeast DC; continue education for the community and primary care providers and continue collection of evaluation data on program effectiveness.
Partnerships:
Community (Ward 8 Health Committee, YMCA, and barbershops/salons), Local government (Department of Parks and Recreation, Community Gardens, FitDC), Academia (University of the District of Columbia and George Washington University), Health (UMC psychiatry, outpatient mental health clinics ) and Faith-based (Mathews Memorial Baptist Church).
Evaluation Strategies:
We plan to collect data on the following (not a comprehensive list): Number of patients screened and referred to MBH, evaluation of primary care provider knowledge on SBIRT and motivational interviewing, evaluation of community member knowledge on Mental Health First AID, and evaluation of ED utilization for MBH pre- and post-intervention.
