Current national trends indicate that each year more people die of overdoses—the majority of which involve opioid drugs—than died in the entirety of the Vietnam War, the Korean War, or any armed conflict since the end of World War II. Each day 90 Americans die prematurely from an overdose that involves an opioid. (Rudd et al., 2016b) We are surely facing an epidemic of colossal proportions, yet this is not the first time that the behavioral health field has witnessed an epidemic of opioid deaths. Rather, the question facing us is, what can we do differently this time around? What we do know is that providing fractured services only addressing one piece of an individual’s condition has not worked.
Given the profound systemic changes in our health care delivery system, and a keener appreciation of the social determinants of health and a person-centered model of care, behavioral health providers must transition to an integrated treatment model tailored and dedicated to address the complicated life needs of those with co-occurring mental health and substance use disorders, in addition to physical health needs. Without an integrated, seamless treatment model in place, providers are not on the path of delivering “whole health care” to the individuals they serve. At the Mental Health Association of Westchester (MHA), we are enhancing the provision of integrated services across our diverse array of agency programs. Our focus on whole health encompasses care for behavioral health and physical health conditions that impact the lives of our clients. This focus is reflective of MHA’s philosophy that person-centered treatment is one of self-determination, choice and recovery.
Many factors were behind the push to integrate behavioral health, and the larger physical health systems, including legislative changes that impacted the market. At the federal level, there are three examples of legislation that were passed to support integration: first, the Medicare Improvements for Patients and Providers Act of 2008 eliminated co-pays for outpatient substance use services; second, the Mental Health Parity and Addiction Equity Act of 2008 required that health plan benefits for substance use and mental health services were covered the same as physical health benefits; third, the Patient Protection and Affordable Care Act (ACA) of 2010 increased access to integrated behavioral health services by expanding insurance coverage through Medicaid expansion. These services are part of the ACA’s required Essential Health Benefits in small employer and individual insurance markets. Specialty care providers, like mental health clinics, were forced to adopt evidence-based therapeutic practices and convert to robust information systems to accommodate the demands for clinical, billing and outcome data from regulators, managed care payers, grantors, etc. This has resulted in a change from volume-based to value-based models. These models require providers to adopt initiatives that result in the improvement of measurable clinical outcomes that demonstrate team-based care provision and coordination. But perhaps the largest factor for the integration of health care, be it mental health, substance use and/or physical health, is that it is the best practice. People are not compartmentalized, and treatment should not be so either. MHA believes that by adopting this approach to treatment of the person as a whole, we will have a better chance of successfully addressing the opioid epidemic this time around.
MHA has approached the transition to integrated care in a staged fashion. During 2018 our agency acquired DSRIP funds through the Montefiore Hudson Valley Collaborative to provide integrated treatment to those with co-occurring disorders in our Westchester mental health clinics. It allowed us to initiate substance use disorder treatment into our clinics in Yonkers, White Plains and Mt. Kisco. Our mental health clinicians use evidence-based practices, including Cognitive Behavioral Therapy (CBT), Trauma-Focused and Integrative Harm Reduction Psychotherapies, Dialectical Behavior Therapy (DBT) and Motivational Interviewing, and we embed the use of Peer Support Services. We provide a welcoming, caring and safe environment for our clients.
During 2019 we were awarded a SAMHSA Certified Community Behavioral Health Clinic (CCBHC) grant to further enhance and refine our integrated services complement. Given the alarming national statistics that only 1 in 10 individuals receives life-sustaining addiction treatment in the midst of a never-waning opioid tragedy, the CCBHC grant could not have come at a better time. Under the CCBHC grant, enhanced integrated services in our clinics provide expanded accessibility to those with substance use disorders, veterans and their family members, and individuals who are uninsured and underinsured. We provide medication-assisted therapies (MAT) for those with addiction disorders. Our staffing complement has been improved with the addition of Certified Alcoholism and Substance Abuse Counselors (CASACs), mobile clinicians, care managers, family, employment and peer support staff (Certified Recovery Peer Advocates and Certified Peer Specialists). This funding enables us to infuse integrated substance use treatment services not only into our clinics in Westchester County but also into our expanding Rockland clinics. We have applied this philosophy to our other programs such as care management, residential and peer services. In order to continue and further affirm our agency’s commitment to integrated services, we are on the pathway to establishing an OASAS Article 32 certified substance use disorder clinic in Westchester County.
Lastly, in 2019 MHA was awarded the Statewide Health Care Transformation Grant through the Department of Health. In line with the health care delivery transformation goals New York State has established, we will partner with a health care provider to create a comprehensive health center that provides integrated whole person care including primary health care, mental health care, substance use disorder treatment, dental and specialty care in one setting. Systems of care that are fragmented create obstacles to optimal whole person health. By providing coordinated care that addresses the physical, behavioral and social determinants of health, the individuals we treat benefit in a number of ways: there is better access to care; better engagement in care; better coordination between disciplines of care; an improvement in clinical outcomes; a decrease in stigma as the treatment setting is integrated and normalized; and overall improved client satisfaction.
MHA is infusing integrated care services into other non-traditional care delivery settings. At the Westchester Single Homeless Assessment Center (SHAC) our staff includes CASACs who provide thorough mental health and substance use assessments to single individuals housed through the Department of Social Services (DSS). Referrals are provided to community-based services that address the provision of necessary life supports to facilitate an individual’s return to a healthy and productive life. The Assertive Community Treatment (ACT) team provides treatment, care management, intensive outreach and mobile supports in an individual’s own environment. A multidisciplinary team of behavioral health professionals, including CASACs, addresses mental health, substance use, employment, wellness, family support and nursing needs. Treatment in place is ideally suited for the socially isolated or individuals who are physically or psychologically unable to venture out of their living situations. The Intensive and Sustained Engagement and Treatment (INSET) Program provides mobile supports in the form of integrated interventions as an alternative to traditional care programs and supports. Services are targeted to individuals who are diagnosed with a behavioral health condition, and have histories of multiple hospitalizations, substance use issues and/or criminal justice backgrounds.
It has become clear that in order to combat the opioid epidemic and produce better outcomes for all individuals receiving behavioral health care, we must adopt an integrated system of care. One that not only addresses the condition that is initially presented to us but takes into account all the needs of the person, and does so in a collaborative, strengths-based and person-centered approach.
For more information about MHA Westchester and its services, please call (914) 345-5900 or visit our website at www.mhawestchester.org.