July 2010

An anonymous writer once wrote “Life is not measured by the breaths we take, but by the moments that take our breath away.” I’m reminded of this quote because lately it seems that the National Council for Community Behavioral Healthcare (National Council) and our members have been working so hard we have not paused to reflect on the remarkable accomplishments that have dramatically improved clinical and business practices. So let’s stop, take a deep breath, and revel in the recent progress we’ve made that just may take our collective breaths away.

Without a doubt, our most significant accomplishment was our role in working with Congress on the successful passage of a national healthcare reform package. We did yeoman’s work to ensure the Patient Protection and Affordable Care Act signed into law in March 2010 included parity for mental health and addiction services, expansion of Medicaid, the addition of behavioral health organizations and individuals with mental illnesses in the new Medicaid medical home state option, and authorization and increased funding for the SAMSHA grants co-locating mental health treatment and primary care.

With this new law come new responsibilities, which include the duty to properly manage the details of healthcare reform, to improve the quality and efficiency of care, and to get ready to meet the increasing demand for mental health and addictions services.

An example of how the National Council and our members are already improving care to get ready for healthcare reform implementation is our Access and Retention Project. Started in June 2009, the effort involves community behavioral health organizations in three states chosen through a competitive application process. Organizations are provided the tools and resources to make access to care more timely, to address revenue losses due to no-show appointments, and to master technology to improve performance and that can be applied to other problem areas within their organizations. Through our work with more than 60 community-based behavioral healthcare organizations nationwide, the Access and Retention Project has proven that it is feasible to increase engagement in treatment by reducing the time it takes to enter care. This new way of doing business has quickly demonstrated that more expedient access to care improves continuity and more quickly engages consumers.

Another capacity-building initiative is the National Council’s Primary Care-Mental Health Collaborative Care and Learning Community Project. The program was initiated when a 2007 National Council survey of community behavioral healthcare organizations found that while 91 percent of respondents placed a high or medium priority on increasing the quality of general medical care for consumers, only half had the capacity to provide treatment for those conditions, and only one in three had the capacity to provide the services onsite. The program emphasizes rapid-cycle improvements, evidence-based practices, and data collection to improve outcomes for consumers served through partnerships between community behavioral health and primary care providers. It is designed to build the capacity of community mental health organizations and their primary care partners in establishing mutually beneficial relationships, increasing mental health screening and referrals to mental health treatment, creating structures for collaborative care for shared patients, and increasing access to primary care services for persons with mental illness. In 2009, the National Council established, operated, and supported 14 learning communities and collaboratives for 149 pairs of community behavioral health organizations and Federally Qualified Health Centers (FQHCs) serving nearly 120,000 patients. These communities and collaboratives continue to expand in 2010, including an initiative in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Network to End Disparities in Behavioral Health now underway at five sites.

Some breathtaking advances are also taking place among community treatment organizations that want to create a culture conducive to psychiatric leadership, but are hampered by lack of access to training, mentoring, or financial resources. With support from SAMHSA’s Center for Mental Health Services, we are working with nationally recognized leaders to lead year-long learning communities using a comprehensive curriculum designed to develop and enhance effectiveness of community psychiatrists in public sector policy and service settings. The National Council’s Psychiatric Leadership Program is designed to enhance the knowledge, skills, and abilities of psychiatrists who are medical directors in community behavioral health centers. The program enhances the professional satisfaction of medical directors and psychiatrists in centers by equipping the psychiatrist with enhanced knowledge of the public behavioral health system, specific skills in administrative psychiatry, and abilities in organizational leadership. With help from alumni of the program who serve as mentors for the current class, the program has led to improved engagement and retention of psychiatrists, and ultimately improved care for people with behavioral health disorders. Now in its third year after graduating 25 physicians in its first two years, plans are underway to maintain an active alumni grouping of previous participants.

The National Council takes its responsibility seriously to keep our members up to date by offering information, education, and initiatives to meet today’s complex challenges. One of the more popular communications channels have been our live webinars and webcasts. A series of four Understanding Mental Health webcasts to mark "May is Mental Health Month" in 2010 focused on topics to help people recognize the signs and symptoms of common mental illnesses and to learn how to connect people in need with professional, peer, and self-help resources in their communities. The four webcasts drew a participation of nearly 2,000 people.

The May webcasts featured content from the evidence-based public education program, Mental Health First Aid USA. One of the most exciting initiatives to come along in recent memory, the 12-hour certification program, helps healthcare providers, educators, law enforcement officers, faith leaders, employers, and others learn how to handle a mental health crisis. With a proven evidence base for increasing mental health literacy in Australia and other countries, we are spearheading the effort to certify member agencies, consumer organizations, and advocacy groups to conduct training in their communities. The program helps to combat stigma, educate key audiences, and improve access to treatment for individuals with mental illnesses. We have trained some 6,000 people and certified more than 800 instructors across the country since the program started in 2008. By the year 2020, we expect that Mental Health First Aid will be as well known as CPR and First Aid.

Now is not the time to rest on our laurels. With healthcare reform the law of the land, we must be ready to compete on a new playing field where increasing numbers of individuals will have healthcare insurance benefits. Our job is to ensure that their new benefits result in access to effective behavioral health services. I look forward to working with our National Council members every step of the way.

Linda Rosenberg, MSW
President and CEO
National Council for Community Behavioral Healthcare