Thanks for turn­ing spot­light on chal­lenges in men­tal health

Modern Healthcare - - COMMENT -

Hav­ing worked in men­tal health for 30-plus years, led sys­tems in three states and chaired Pres­i­dent Ge­orge W. Bush’s New Free­dom Com­mis­sion on Men­tal Health, I greatly ap­pre­ci­ate the cover story on men­tal health re­form in last week’s is­sue of Mod­ern Health­care (“Men­tal health rises to top of agenda, but has a tough course ahead,” Oct. 10, p. 8). It will help gal­va­nize at­ten­tion on one of the most costly sets of ill­nesses—which still re­ceive in­ad­e­quate at­ten­tion in most health­care set­tings.

My per­spec­tive over the very long term is that care for the brain a gen­er­a­tion ago was like care for kid­neys. Not much was done un­til the level of ill­ness was cat­a­strophic, and then pa­tients were sent to sep­a­rate providers paid from sep­a­rate fund­ing streams, where care ne­glected the rest of the body. An op­ti­mistic view to­day is that care for the brain will be­come like care for the heart—in­ter­ven­tional treat­ments will be avail­able, but pre­ven­tion will be em­pha­sized and most ser­vices de­liv- ered in pri­mary care.

The tran­si­tion to bet­ter, in­te­grated care is slow and pro­ceeds in fits and starts. The re­forms that Congress is con­sid­er­ing, though help­ful, are piece­meal. Mod­ern Health­care’s ar­ti­cle il­lus­trates the op­er­a­tional chal­lenges in re-en­gi­neer­ing care so that it works for pa­tients.

An­other lit­mus test of our com­mit­ment to tak­ing men­tal health se­ri­ously is the chal­lenge of tak­ing sui­cide pre­ven­tion se­ri­ously. The is­sue is cur­rently rel­e­gated to over­whelmed men­tal health set­tings and emer­gency de­part­ments, where care is gen­er­ally in­ad­e­quate com­pared with what we know is ef­fec­tive. The Joint Com­mis­sion’s March 2016 Sen­tinel Event Alert is a sign that sui­cide care must be­come a core re­spon­si­bil­ity in all health­care set­tings.

Michael F. Ho­gan, Ph.D. Ho­gan Health So­lu­tions Al­bany, N.Y.

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